In June 2016, the American-European Congress of Ophthalmic Surgery (AECOS) convened at Villa Miani in Rome for the 6th annual European Symposium. Drawing leading ophthalmologists and industry members from all over the world, the AECOS European Symposium served as a forum for the most progressive minds in eye care to discuss the many technologies, treatments, and events shaping the field. Below is a summary of several noteworthy sessions and snippets of the lively conversation that took place throughout the meeting both onsite and on Twitter.
AECOS INNOVATION FORUM
The European Symposium opened with the AECOS Innovation Forum. Leading off, Franck Leveiller, PhD, described a smart contact lens being developed by Google and Novartis to monitor blood glucose levels in diabetic patients’ tears. Dr. Leveiller described the difficulties of diabetes management that dictated the need for this technology and commented on the potential challenges associated with this approach, such as patients potentially being uncomfortable with their data being stored in the cloud.
Next came a look at adjustable technologies, first with Rajesh Rajpal, MD, Chief Medical Officer of Avedro, presenting on Photorefractive Intrastromal Cross-Linking, or PiXL. Dr. Rajpal shared 1-year results with customized corneal cross-linking (CXL) and provided updates from ongoing investigations, such as PiXL for myopia and transepithelial PiXL. Second, Paul McLean, President and Chief Executive Officer of ClarVista Medical, discussed the Harmoni Modular IOL System and how the ability to safely and easily replace the optic component of the lens makes this “the only IOL system designed to provide complete confidence.”
Following came the Shark Tank session, a hallmark of the AECOS meetings in which presenters introduce early technologies before a panel of judges. The technologies discussed included a continuous real-time refractive imaging device (Holos IntraOp; Clarity Medical Systems), a thermal laser capsulotomy device (CapsuLaser), and very high frequency digital ultrasound (ArcScan). Also described was a new concept of electronic presbyopia correction (Vistalens Bionic accommodating IOL), microelectrostimulation of the ciliary body to restore accommodative loss, the Catapulse system for no-ultrasound cataract surgery, the role of tear osmolarity in surgical patients, and allogenic corneal inlays and onlays (TransForm; Allotex). As evidenced by these techniques and technologies and the positive experiences seen thus far with their use, innovation in ophthalmology is clearly thriving.
TODAY’S CLINICAL CHALLENGES
The Today’s Clinical Challenges session began with a focus on the diagnosis and management of dry eye disease (DED). Luigi Marino, MD, PhD, shed light on the inner workings of the DED patient, highlighting components of what makes a proper psychological evaluation. Dr. Marino stressed the importance of recognizing both the verbal and nonverbal cues of patients with DED and methods for effective communication and education with them and their relatives. Next, Miguel Teus, MD, weighed in on the role of tear osmolarity in various patient populations, including those with primary open-angle glaucoma and those with previous cataract surgery or LASIK. Last, Kendall Donaldson, MD, discussed diagnostic tests for DED, which she called the most frequently encountered disease state by ophthalmologists. Dr. Donaldson described the 13 tests included in her full evaluation of DED and described how dry eye diagnostics and treatment paradigms are evolving from subjective to objective.
The next challenging area of practice broached was the use of intracameral antibiotics. Jorge Alió, MD, shared insights into intracameral strategies in Europe, highlighting risk factors for endophthalmitis and strategies for prophylaxis in Spain. In response, Quentin Allen, MD, discussed how the use of intracamerals varies between Europe and the United States. As Dr. Allen shared, about 70% of European surgeons use intracameral antibiotics but US surgeons are far behind. In the subsequent discussion, surgeons weighed in on the findings of and reactions to the landmark European Society of Cataract & Refractive Surgeons (ESCRS) study on intracameral antibiotics and talked about ways in which the varying medicolegal environments in Europe and the United States influence practice patterns.
Up for debate next was the utilization of single-use instruments. Julian Stevens, MD, commented on the quality of disposable instruments and stated that, if given the option, most patients would elect to pay an additional fee for their use. Additionally, Fritz Hengerer, MD, weighed in on the economics of single-use instruments and how he has made them work financially in his practice. A lively conversation ensued, during which attendees shared alarming stories of surgeons washing and reusing single-use instruments and discussed the ability to charge extra for this approach in Europe versus the United States.
Due to the ubiquitous nature of the condition and aging population, presbyopia was a hot topic at the European Symposium. John Vukich, MD, discussed his experience with the Kamra inlay (AcuFocus), noting minimal compromise in stereoacuity and that the device is unaffected by presbyopia progression. Arthur Cummings, MD, shared his experience with the Raindrop Near Vision Inlay (ReVision Optics), describing the ideal candidates for this solution and citing a 92% patient satisfaction rate at 12 months in clinical trial. Looking at an alternative method of presbyopia correction, Pavel Stodulka, MD, shared his preferred approach for monovision laser vision correction. Following these talks, the panelists led speakers and audience members in a discussion about which inlay is best conceptually and whether presbyopia is a contraindication to the creation of a LASIK flap.
Entering the regulatory environment, Michael Mrochen, PhD, provided an overview of new guidelines recently agreed upon in the European Union. Dr. Mrochen discussed how these regulations will emphasize improved patient safety and promote timely access to health care solutions as well as how these rules will affect the ophthalmic industry and clinicians. Next, Malvina Eydelman, of the FDA, described the organization’s Network of Experts and its functions in the United States. According to Dr. Eydelman, Europe could benefit from implementing a similar model, through which a vetted network of outside scientists, clinicians, and engineers offer expertise to policymakers when needed.
SPOTLIGHT ON NEW IOL DESIGNS
The Spotlight on New IOL Designs session showcased a range of innovative concepts in lens technologies. First, Burkhard Dick, MD, discussed the use of the IC-8 small-aperture IOL (AcuFocus) in patients with highly aberrated corneas. Next, Samuel Levinger, MD, shared his insights into outcomes and patient satisfaction after unilateral lens exchange with a trifocal diffractive IOL in presbyopic emmetropes. Tobias Neuhann, MD, introduced the EVO+ Visian ICL (Staar Surgical), comparing the spherical and toric versions, and Sheraz Daya, MD, overviewed a variety of trifocal IOLs, including the Panoptix (Alcon) and Acriva (VSY Biotechnology) lenses, citing a 0% explantation rate in more than 2,500 procedures. Erik Mertens, MD, commented on his use of the WIOL-CF, a bioanalogic accommodative IOL, and shared a video of his first case. Then attendees engaged in a discussion on extended depth of focus IOLs, deliberating their advantages, various uses, and indications and contraindications.
MIGS: WHAT IS THE OPPORTUNITY?
Transitioning to the glaucoma space, the MIGS session explored the potential opportunities of these devices and procedures. Steven Vold, MD, delivered a talk on the changing paradigms of glaucoma care, describing the next-generation devices—from stents to implants—and their timelines for regulatory approval. Next, Arsham Sheybani, MD, shed light on the concept of applying fluidics to make glaucoma surgery safer with the Xen 45 implant (Allergan). Dr. Sheybani stressed the need for standardization in glaucoma surgery as has been achieved in cataract surgery. Following, Dr. Vold presented results from the COMPASS study evaluating the CyPass Micro-Stent (Transcend Medical), and Kuldev Singh, MD, commented on why he believes the future of MIGS is so bright, including an expanding clinical need, rapid innovation, and successful collaborations, such as those fostered by AECOS.
TECHNOLOGIES ON TRIAL
With the AECOS Court in session, the Honorable John Marshall, PhD, took the bench to judge ophthalmic technologies on trial. Surgeons argued for and against a range of stances, including (1) if phakic IOLs should be implanted same day bilaterally or not, (2) whether refractive lens exchange should be performed in emmetropes, and (3) if intraoperative aberrometry is warranted in every case. Following statements from the defense and prosecution, Judge Marshall and his jury—panelists Dr. Alió; Steven Dell, MD; Dr. Dick; and John Kanellopoulos, MD—named one surgeon per case the victor.
LAMELLAR REFRACTIVE SURGERY
Bringing industry to the frontlines, the Lamellar Refractive Surgery session began with a look at what can be expected from the ophthalmic companies in terms of efforts to revitalize LASIK. Leaders from Alcon, Abbott, Bausch + Lomb, Schwind, Ziemer, and Zeiss gave attendees a peek at what their teams are doing to ensure the future of laser refractive surgery, whether through technological advances, revolutionary advertising campaigns, novel procedures, and more.
Then ophthalmologists engaged in a debate that, for the past few years, has been at the forefront of the field: SMILE vs LASIK. Stephen Slade, MD, reminisced about a time when LASIK was so successful that surgeons abandoned all other procedures and shared his experience with SMILE, noting essentially equivalent results. Mounir Khalifa, MD, compared the use of SMILE with wavefront-guided LASIK for the treatment of low, moderate, and high myopia; Dr. Khalifa stated that, in his experience, wavefront-guided LASIK was significantly better than SMILE in terms of safety, efficacy, and predictability in this patient group. John Doane, MD, commented on the marketing of these procedures, remarking that no surgeons are marketing SMILE and converting patients to LASIK. Closing out the session, Matthias Elling, MD, projected where PiXL will fit into this scene; according to him, although the long-term stability of PiXL is unknown, initial results after 12 months are promising.
In both everyday practice and bigger-picture efforts like rebooting LASIK, reputation management is an important aspect for ophthalmologists and industry alike. Recognizing this, AECOS dedicated a session to discussing what to do and what not to do when faced with a public relations (PR) nightmare. With commentary from onsite PR expert Sharon Plunkett, AECOS attendees heard a case study in active crisis management from Jim Mazzo. Mr. Mazzo described the changing face of the media today and maintained that surgeons and industry cannot ignore the media’s inquiries about LASIK but that it is important to be properly prepared.
Dr. Stevens described the aftermath of the NICE report on laser eye surgery in the United Kingdom, referencing the immediate 40% reduction in laser vision correction, and commented that the media “wants magic or tragic.” Next, Dr. Vukich detailed AECOS’ partnership with the American Refractive Surgery Council (ARSC) and the Refractive Surgery Alliance (RSA) to help defend LASIK against misinformation and sensationalism. Following, Ms. Plunkett led attendees in an insightful discussion about how to handle negative press and how to promote positive messaging on both a micro and macro scale.
MORE FROM AECOS
For more highlights from the AECOS European Symposium, view a video showcase of select talks at http://eyetube.net/series/daily-coverage-aecos-rome-2016/. Stay up to date on future AECOS events at www.aecosurgery.org and follow @AECOSurgery on Twitter. AECOS looks forward to the 2017 European Symposium next summer in Prague.