Best of the best 36th ESCRS Congress

This year’s Congress combined the best of research and practical applications

Howard Larkin

Posted: Friday, December 7, 2018

At the risk of sounding biased, ESCRS Treasurer Thomas Kohnen MD, 
PhD, found the 36th Congress of the ESCRS in Vienna one of the most valuable ophthalmology meetings this year – and he attended events all over the world.
“Because we have some basic research integrated [with clinical research and education] it is just the right amount of information for those who practise in our field,” said Prof Kohnen, who is chair of the department of ophthalmology at Goethe University, Frankfurt, Germany.
That opinion was shared by many attendees who emailed ESCRS Secretary Oliver Findl MD, founder and chair of the Vienna Institute for Research in Ocular Surgery, and chair of ophthalmology at Hanusch Hospital, Vienna.
“In general, the meeting was very well received; both the content and the location and atmosphere were good. Of course, these are subjective impressions, but I got a lot of feedback that it was the best ESCRS meeting until now,” Dr Findl said.
The diversity of delegates and quality of presentations made the long journey from India worth it, said Soosan Jacob MS, FRCS, DNB. “It’s a treat to see so many bright minds at one place, to make new friends, meet old ones and to learn new things,” said Dr Jacob, who is director and chief of Dr Agarwal’s Refractive and Cornea Foundation at Dr Agarwal’s Eye Hospital, Chennai, India.
ESCRS President Béatrice Cochener-Lamard observed that worldwide participation and flexibility help keep ESCRS programming current and valuable. This year notable topics included the rise of small-incision lenticule extraction (SMILE®) and transepithelial PRK in the corneal refractive realm, and the growing interest in extended depth of focus, trifocal and toric IOLs for cataract and refractive lens exchange.
“Year after year the hot topics change for different reasons, and we keep on top of it,” said Dr Cochener-Lamard MD, PHD, who is Professor and Chairman of the ophthalmology department at the University Hospital of Brest, France.

Myopia challenges
The growing prevalence and severity of myopia around the world made a research symposium on its causes and potential treatments to slow progression especially relevant, Dr Findl said.
Frank Schaeffel PhD, head of neurobiology of the eye at the University of Tübingen, Germany, presented new animal research suggesting that differences in stimulation in local areas of the retina, and not just peripheral hyperopic defocus, may drive myopia progression. The findings suggest designing new lenses that project 
images at multiple distances may help slow progression – and going back to green or amber letters on a black background for computer monitors might help as well.
However, these hypotheses have not been tested in humans, which would take years and many patients, 
Dr Findl noted.
On the treatment side, Pauline Cho PhD, of Hong Kong Polytechnic University, presented information on using orthokeratology and specially designed contact lenses that correct peripheral defocus to slow myopic progression, though these require additional research to demonstrate 
and improve performance. Donald 
Tan MD, PhD, of the Singapore Eye Centre, reported the latest on using atropine drops.
Marlies Ullrich MD, of the Vienna Institute for Research in Ocular Surgery, discussed potentially preventing retinal detachment in myopic patients with prophylactically photocoagulating areas of lattice degeneration and apical holes in patients at risk due to posterior vitreous detachment. More evidence is needed to assess efficacy and develop guidelines for prophylactic treatment, 
Dr Findl said.
Mor Dickman MD, PhD, of Maastricht University, the Netherlands, presented animal research on scleral cross-linking to prevent progression. However, potential side-effects such as retinal toxicity and glaucoma must be examined in further research, Dr Findl noted.

Presbyopia is another condition with unmet need around the world, Prof Kohnen said. In addition to many papers on lenticular and corneal solutions, research presentations 
helped show the potential for 
improving treatment.
These included presentations of a finite element analysis of accommodation mechanisms and the functional anatomy of the zonules, which could help improve accommodating lens designs.
On the treatment front, research suggests femto lentotomy might help restore lens flexibility, Prof Kohnen noted. For premium IOLs, extended depth of focus lenses are gaining ground “and the winner among multifocal lenses is the trifocal, especially the torics”, Dr Cochener-Lamard said.
Dr Jacob especially enjoyed Rudy Nuijts MD, PhD’s Ridley Medal lecture, which was entitled “Facts first – the search for evidence”. It reminded everyone that ongoing research is essential to ensure innovative new techniques, such as using femtosecond lasers in corneal surgery, live up to 
their potential.
The practice development programme on the benefits and risks of social media, at which she presented, was helpful as well, she added.
The latest developments in 
corneal cross-linking, surgical presbyopia correction and the video awards filled out Dr Jacob’s list of favourites. “It makes me proud when 
I see the skill, knowledge and ingenuity of my colleagues and peers on display,” she said.
Similarly, Dr Findl found the interactive video cases instructive. “It’s fascinating to see how people work through the different steps of surgery and decide on the best course to follow. There are often several roads to Rome and there’s not always just one option that may be the right one.”

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