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Clinical research

Symposia highlight important new and upcoming ophthalmic breakthroughs

Howard Larkin

Posted: Monday, September 21, 2020

Jesper Hjortdal MD, PhD, DMSc

Clinical research is the future of ophthalmology. This year’s ESCRS Clinical Research Symposia, to be held 3 October live from the ESCRS Virtual Congress 2020, highlight four current areas of vital advances.

“The programme is mainly research-based, to address what’s new, what is coming in the future, what is not implemented yet, or implemented only in a few clinics to make it more widely known,” said ESCRS Research Committee Chair Jesper Hjortdal MD, PhD, DMSc.

Delegates will participate virtually – but not impersonally. All attendees will be able to ask questions online in real time, and each of the four symposia will be followed by a 30-minute interactive discussion including audience questions. “It may attract even more attendees because people do not have to fly in and pay for hotels,” said Dr Hjortdal, who is also clinical professor at Aarhus University, Denmark, and medical director of the Danish Cornea Bank.

As always, this year’s topics result from consultations by the ESCRS Clinical Research Committee, which also identifies research projects for ESCRS support.

Dr Hjortdal briefly discussed the four topic areas and why they were chosen.

Artificial intelligence

While still in their early days, machine learning and other AI approaches are increasingly pervasive and powerful in ophthalmology, and in medicine and society generally, Dr Hjortdal noted. The symposium will examine both the roots of AI and how it can be used for clinical research as well as some specific applications in use and development.

The breadth of these AI applications is impressive. One presentation examines developing machine learning-accessible electronic health records to enable AI-powered registry studies that could leverage clinical data from millions of patients. Another explores digital eye testing in cataract and refractive care, which could improve patient care and convenience by enabling telemonitoring of patients after surgery.

Current anterior segment AI applications to be presented include IOL power calculation formulae using deep machine learning programmes that increase predictive accuracy, particularly for very long and very short eyes that give conventional formulae fits. AI is also in use for detecting corneal ectasia and, importantly, risk of ectasia. A new application for classifying corneal dystrophies will also be discussed.

Biomarkers

Biomarkers, including both chemical and physical indicators of pathological states and biological processes, are another technology exploding across the ophthalmic and general medical landscape. Detecting a specific protein or combination of proteins is making it possible to identify more precisely the causes of a wide range of inflammatory diseases, making it possible to better tailor treatments, Dr Hjortdal said.

For example, staining and tear film analysis may not yield the precise results needed to identify the causes of dry eye which may be revealed through protein analysis, Dr Hjortdal said. Similarly, chemical biomarkers can detect viral infections.

On the physical biomarker side, development of criteria for definitively diagnosing keratoconus will be presented. Beyond the eye, measurement of retinal nerve layer thickness may be a biomarker for neurodegenerative diseases, such as multiple sclerosis and Wilson disease.

Detection of these physical biomarkers, as well as chemicals associated with specific disease states, overlaps AI to a certain extent. Biomarkers potentially may be found in any procedure specimen, so storing and analysing fluids and other debris from procedures can be an important way of identifying new biomarkers. The biomarkers journey from clinic to laboratory back to the clinic will also be discussed.

Intrastromal femtosecond laser surgery

Advent of the femtosecond laser and more recently SMILE® intrastromal lenticular surgery technology are revolutionising both refractive and therapeutic surgery, Dr Hjortdal said. A range of recent innovations in the field will be discussed.

On the refractive side, lenticule extraction or implantation may be the future for correcting hyperopia. Intrastromal lenticule rotation may help address mixed astigmatism.

Stromal implants may also be useful for treating corneal disease and for treating ectasia. Bioengineered and synthetic stromal lenticules may also soon be available.

Presbyopia treatment

Closer to the current clinical realm, the day’s final clinical research symposium will address current treatments for presbyopia. General topics will include a discussion of current understanding of accommodation and how it influences the design and use of presbyopia correcting technology. Measuring outcomes and how well they meet actual patient needs will also be discussed.

On the treatment side, recent advances in pharmacologic, laser and corneal inlay procedures will be presented. Discussions will include improving outcomes in high correction corneal refractive procedures, Dr Hjortdal added. New crystalline lens treatment approaches will be included as well.

Overall, Dr Hjortdal expects a high-quality programme from prominent researchers worldwide, who accepted what has become a prestigious invitation to participate. “I know when I was first invited, I was a little bit proud,” Dr Hjortdal said.