Thinking outside the box

The Binkhorst Medal Lecture will take place on Sunday 15 September at 10.00 in the Auditorium

Cheryl Guttman Krader

Posted: Thursday, September 12, 2019

Ehud Assia MD
Ehud Assia MD will be awarded the 2019 Binkhorst Medal during the opening ceremony of the 37th Congress of the ESCRS on Sunday 15 September.
Dr Assia is currently Director of the Center for Applied Eye Research at the Meir Medical Center, Kfar-Saba, Israel, Professor of Ophthalmology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, and Medical Director, Ein Tal Eye Center, Tel Aviv, Israel.
Speaking to EuroTimes, Dr Assia said that he is grateful and honoured to have been chosen as the next recipient of the Binkhorst Medal.
“I feel that the Binkhorst Medal is a kind of lifetime achievement award that represents one of the highest levels of recognition that a cataract surgeon can receive,” said Dr Assia.
“I am thankful to the committee members who selected me for this great privilege, and I am honoured to be joining a ‘club’ whose other members are known for the significant contributions they have made to the field.”
Dr Assia is a prolific author of peer-reviewed articles and book chapters and holds patents for several novel devices and instruments. In his Binkhorst Medal Lecture, which is titled “Thinking outside the box: new perspective on current surgical technologies”, Dr Assia will be speaking about the power that comes from challenging conventional thinking and illustrating this point with examples of how assessing situations from a different perspective led to his various innovations that are relevant to cataract surgery.
“Throughout my career I have been involved in research aimed at developing new surgical devices and technologies. In doing so, I have always considered issues from different angles and with a non-conventional view because I believe that approach is what leads to creative new ideas,” he said.
In his talk, Dr Assia will begin by mentioning the side-view technique that he developed with Dr David Apple as a new method for studying the anterior chamber anatomy in post-mortem eyes. Also known as the “keyhole technique”, it involves creating a uveoscleral window, and it provides a clear, three-dimensional view of the crystalline lens or pseudophakic implant, zonular apparatus and ciliary body.
Phaco fluidics
The major portion of Dr Assia’s lecture will be devoted to sharing the work he has been doing to improve fluidics during phacoemulsification and to maintain corneal endothelial safety during cataract surgery. His goal for developing new fluidics technology is to maintain stable pressure within the anterior chamber throughout the procedure.
“My main focus and message relate to phaco fluidics,” he told EuroTimes. “Phaco surgery depends largely on fluid irrigation and maintaining the volume of the anterior chamber and the intraocular pressure. For most surgeons this is done by using a passive irrigation of fluid (BSS) delivered through the machine handpiece and this has not changed in the last 50 years since the early days of phacoemulsification. In my talk I challenge some of these traditional concepts,” he said.
“New technologies have been helpful for maintaining anterior chamber stability during phacoemulsification, but still, the anterior chamber collapses and the IOP often drops to zero whenever the phaco tip is withdrawn from the eye,” said Dr Assia.
“My idea was to look at the situation from a different perspective to identify a method for maintaining steady pressure throughout surgery, independent of the phaco handpiece, and utilising an automated pump to achieve continuous active maintenance of anterior 
chamber pressure.”
In addition, instead of using only BSS as the irrigating solution, Dr Assia proposes using a diluted viscoelastic substance, instead of BSS, which provides corneal endothelial protection and allows a slow-motion operation, and incorporating compounds that are free radical scavengers to protect against corneal endothelial damage caused by ultrasound energy-generated free radicals.
Dr Assia is working with industry partners to implement his innovations. In his Binkhorst Medal Lecture he will be presenting videos and a large bank of evidence from preclinical and clinical studies that demonstrate the concepts and their benefits.
“The bottom line of my presentation is that it’s time now for a second thought on the conventional way we utilise phaco fluidics and there are so many things that we can do to make this simple, yet important, component of cataract surgery a much better surgical tool,” he concluded.
The Binkhorst Medal Lecture will take place on Sunday 15 September at 10.00 in the Auditorium