Promises and challenges

Howard Larkin

Posted: Friday, December 7, 2018

Pavel Stodulka MD, PhD, Beatrice Cochener-Lamard MD and Mario Nubile MD d at the ESCRS Symposium at Refractive Surgery Subspecialty Day

The road to the future for our profession has never been more promising or challenging,” AAO President-Elect George A Williams MD told the opening session of the American Academy of Ophthalmology 2018 Annual Meeting in Chicago. New therapies and technologies for preserving and restoring sight are the promise. How society will pay for them is the challenge, said Dr Williams, a retina and vitreous specialist who practises in Royal Oak, Michigan, USA.
In the USA, it is widely accepted that about $1 trillion of the $3.5 trillion spent annually on health care is wasted on low-value care and over-treatment, Dr Williams noted. As a result, payment is moving from a volume-based system to a value-based system.
“Today ophthalmologists and all physicians practice in a world of measured performance and cost transparency. In the coming years the metrics will become more difficult and the bright light of accountability will shine even brighter,” Dr Williams said. Patients, insurers, government and businesses will have more performance data and will hold physicians accountable for delivering value.
“The obvious question is what is value and who shall define it,” Dr Williams said. The positive impact that services have on individual patients’ quality of life is a critical factor – and one that ophthalmology is well prepared to demonstrate, he added.
“I believe we should embrace this transition, because in a true value-based system, ophthalmology wins,” said Dr Williams, who for years has worked with government agencies on value-based care. He cited the 98% success rate of cataract surgery in restoring vision for life for a cost of less than $2,000 as an example of the value ophthalmology brings. “What we do changes lives.”
Supporting data gathering through AAO’s Intelligent Research in Sight (IRIS) registry is critical to getting the word out. With more than patient records from 52 million patients to date, IRIS is the world’s largest clinical database, Dr Williams noted.
With its contributions to improving the quality and effectiveness of ophthalmic care and making the case for its value to patients, IRIS has changed and will continue to change the AAO, moving it toward greater value for patients, Dr Williams said. “We have chosen the road to demonstrate the value of ophthalmic care. It will not be straight, it will not be easy. But we know where we are going.”
Injuries from unapproved ocular cell injection therapies are underreported by the clinics administering them, said researchers from the University of Rochester and the University of Miami.

AAO highlights
• Steven T Charles MD was named AAO 2018 Laureate based on his lifetime work developing techniques and technology for vitreoretinal surgery.
• Philip J Rosenfeld MD, PhD, delivered the Jackson Memorial Lecture outlining the development of anti-VEGF therapy for treating wet AMD, and the epic struggle with industry and the FDA to preserve patient access to compounded bevacizumab as an affordable alternative.
• A device for delivery of ranibizumab for periods up to one year for patients with age-related macular degeneration may be available in about three years following a successful trial, said researchers at Wills Eye Hospital. The device could reduce the need for frequent intravitreal injections while improving outcomes.
• Metformin, commonly used to control type 2 diabetes, may be protective against development of age-related macular degeneration, according to researchers in Taiwan.
• A popular online symptom checker operated by WebMD incorrectly diagnosed ocular symptoms 74% of the time and often underestimated their severity, often leading to inappropriate recommendations for self-care, found a study by researchers at McMaster University in Canada.

• Pavel Stodulka MD, PhD, Beatrice Cochener-Lamard MD and Mario Nubile MD discussed Small Incision Lenticule Extraction (SMILE) outcomes and complications at the ESCRS Symposium at Refractive Surgery Subspecialty Day.