ESCRS Heritage Lecture – Theo Seiler

Cheryl Guttman Krader

Posted: Friday, September 4, 2020

Theo Seiler, MD, PhD

Theo Seiler, MD, PhD, will deliver the third annual ESCRS Heritage Lecture during the virtual 38th Congress of the ESCRS. In his talk, which will be broadcast live on Sunday, October 4, at 14.00 CET 2020, Prof Seiler will speak on the topic “Cataract Surgery and Laser Vision Correction”.

Prof Seiler said he is honoured to have been chosen as the ESCRS Heritage Lecturer and to follow in the footsteps of Thomas Neuhann, MD, and David Spalton, MD, two giants in cataract surgery who preceded him as Heritage Lecture speakers.

The Heritage Lecture was introduced at the 2018 ESCRS Congress with the aim of highlighting important developments in the history of anterior segment surgery. Prof Seiler will focus on what he calls “synergism between laser vision correction (LVC) and cataract surgery” and explain how LVC can improve the results of cataract surgery, particularly for cataract patients who chose implantation with a toric or multifocal IOL with the goal of reducing spectacle dependence.

The main portions of Prof Seiler’s Heritage Lecture will be divided between discussing why a history of LVC makes it so difficult to achieve good refractive results after cataract surgery and how to use LVC to increase the rate of patient satisfaction.

“LVC was introduced more than 30 years ago, and now an increasing number of post-LVC patients are presenting with ‘recurrency of myopia’ that is associated with nuclear cataract. However, we are faced with a new problem in this patient population as we try to consistently achieve the target refraction and deliver quality vision,” said Prof Seiler, Managing Director and Head of Ophthalmology, Institute for Refractive and Ophthalmic Surgery, Zurich, Switzerland.

Prof Seiler will explain that although significant improvements have been achieved in IOL power calculations due to advances in optical biometry for determining axial length, optical biometry-acquired keratometry measurements tend to be inaccurate in postLVC eyes. Therefore, Prof Seiler emphasises the routine use of a dedicated corneal tomography unit to determine keratometry in these cases.

He added that a LASIK enhancement procedure is facilitated in patients with a history of LASIK because of the ease of lifting the flap.

“It is easier and safer to do a flap relift than to cut a new flap after cataract surgery,” Prof Seiler said.

Prof Seiler will begin his lecture by giving a brief history of LVC. He will recount that while on faculty at the University of Berlin, he was a member of one of two independent working groups that visited the Lambda Physik Laboratories in Göttingen, Germany to test the value of excimer lasers for keratectomy.

“In Berlin in 1985, we did the first clinical phototherapeutic keratectomies with promising results and considered the induced refractive change as a welcome side effect,” Prof Seiler said.

Photorefractive keratectomy (PRK) was first reported in 1987, and Prof Seiler and colleagues published results from the first prospective study of PRK in 1990. Although PRK quickly became the leading procedure for myopia correction worldwide, it was supplanted by LASIK a few years later. Prof Seiler credits Richard Maloney, MD, with reporting the first case of LVC after cataract surgery.

“We know from a study published by ophthalmologists at Moorfields Eye Hospital that only 68% of patients who received a multifocal IOL were satisfied with their vision and 25% were not satisfied at all,” said Prof Seiler.

“As we reported in a paper published in 2019 in the Journal of Refractive Surgery, selective wavefront-guided LASIK in patients who are unhappy after cataract surgery can address those issues and increase patient satisfaction,” he told EuroTimes.

“It turns out that significant residual astigmatism is a main factor along with optical aberrations, and specifically second and higher order coma that is induced by IOL decentration. This points to the benefit of enhancement with a selective wavefront-guided ablation.”

Ending his talk with information on LVC after cataract surgery, Prof Seiler will discuss the outcomes from his published series that reported on 56 eyes of 42 patients who were dissatisfied after cataract surgery with implantation of a trifocal IOL. The patients underwent treatment with selective wavefront-guided LASIK that was planned to correct for all aberrations except spherical aberrations to preserve the apodization and enhance the IOL’s multifocal effect. The refractive target was achieved in 98% of eyes and patient satisfaction increased.

“Using this technique to correct residual astigmatism and reduce higher order aberrations, the overall satisfaction rate jumped to 98%. Dry eye, which can be worsened by LASIK, was the reason for remaining dissatisfaction, and that underscores the importance of careful patient selection for LASIK,” Prof Seiler said.