The 2016 American-European Congress of Ophthalmic Surgery (AECOS) Winter Symposium in Aspen, Colorado, kicked o with updates on the organization from Arthur B. Cummings, MD, and John A. Vukich, MD. As President of AECOS Europe, Dr. Cummings discussed plans for the upcoming 2016 AECOS European Symposium in Rome, Italy, which will feature a young ophthalmologists’ program and informative sessions on the psychology of dry eye patients, extended depth of focus IOLs, and more. Dr. Vukich, President of AECOS America, announced the organization’s new charitable a liation with a Central American eye clinic, through which AECOS will aim to promote education and training among local ophthalmologists.
Practice/Malpractice Update
The “Practice/Malpractice Update,” delivered by legal experts Alan Reider, JD, MPH, and Allison Shuren, MSN, JD, provided attendees with up-to-date insights into common malpractice risks faced by ophthalmologists and how to best avoid them. First, Ms. Shuren discussed the importance of thorough documentation, noting that the Ophthalmic Mutual Insurance Company (OMIC) reports that a majority of malpractice claims relate to cataract surgery, with the dilated retinal exam being the most poorly documented part. According to Ms. Shuren, documentation may mean the di erence between showing a maloccurrence versus malpractice.
Mr. Reider detailed the risks associated with bilateral sequential cataract surgery, stating that the most important factor with this approach is thorough informed consent. Ms. Shuren and Mr. Reider then moved on to shed light on two areas of practice that are becoming more routine: in-o ce cataract surgery and comanagement of refractive procedures. As Mr. Reider discussed, comanagement of covered procedures raises limited compliance issues, but comanagement of refractive surgery presents several potential issues; further, premium IOL procedures have inspired comanagement arrangements that likely would be viewed as problematic by regulators, Mr. Reider said.
Ms. Shuren commented on the sale of drugs in an ophthalmic practice, advising physicians that if they sell drugs to patients in their practices, they must ensure that they are not dispensing outside their specialty. Additionally, she recommended that physicians use caution if stocking controlled substances. Closing out the “Practice/Malpractice Update,” Mr. Reider touched on the repayment of Medicare overpayments, emphasizing that physicians must issue all refunds within 60 days.
Industry Insights
As an organization designed to foster collaboration between physicians and industry, AECOS invited executives from a range of companies—including Carl Zeiss Meditec, Allergan, Abbott Medical Optics, and Alcon—to share updates on their efforts in the ophthalmic space and their projections for the future of ophthalmology. Following these updates, James Mazzo led the industry leaders in a panel discussion, inquiring first about they keep their teams motivated in light of acquisitions and mergers. Mr. Mazzo also questioned how to keep investors attracted to ophthalmology and confident that it is a robust and growing market; as he described, the field needs analysts to encourage investors, but the number of analysts in ophthalmology has decreased. Rounding out the discussion, Mr. Mazzo asked industry members to share pearls for remaining competitive yet working together to, say, promote a procedure such as LASIK.
Lasik Reboot
Keeping with the concept of a LASIK reboot, Dulaney Award recipient Eric D. Donnenfeld, MD, presented a lecture titled “How Good Is LASIK?” in which he examined the myths, misconceptions, and reality of this procedure. According to Dr. Donnenfeld, common myths associated with LASIK include that physicians do not undergo LASIK, that there are no long-term data for the procedure, that LASIK is not as safe as contact lens wear, that the procedure increases the risk of halos and glare, that the safety and efficacy of LASIK has not improved over time, and that LASIK causes dry eye. Discounting all of these beliefs, Dr. Donnenfeld concluded that LASIK is the safest, most successful, and most studied elective procedure and, thus, is worth saving.
Keynote speaker Kerry Solomon, MD, also weighed in on the procedure with insights on late-breaking LASIK news. As Dr. Solomon explained, surgeons continue to reference the FDA Kremer trial, the first LASIK study, and perhaps use these early outcomes as justification to not perform the procedure. In his own review of LASIK, which he called “the best-kept secret around,” Dr. Solomon found nearly 5,000 articles on the procedure, indicating it is, in fact, a well-studied surgery. Based on his analysis, Dr. Solomon concluded that modern LASIK is significantly safer and more effective than when it was first approved.
Continuing to explore LASIK, in “The Great Debate III: What Will Save LASIK?” session, Dr. Vukich; Alan Faulkner, MD; and Sandy Feldman, MD, deliberated what, if anything, can be done to hit the reset button on this procedure. Dr. Vukich maintained that maybe it is not about saving LASIK but about advocating a new procedure, such as SMILE. Dr. Faulkner argued that LASIK is a successful product that will be saved by better outcomes, made possible by new approaches such as topography-guided LASIK. Dr. Feldman discounted the perception of LASIK as an old procedure and stated that LASIK is not dead and business can grow if a practice and its surgeons formulate and execute an appropriate approach.
IOL Accuracy
Like LASIK, IOL accuracy was also subject to a lively debate, hosted by Douglas Koch, MD; William F. Wiley, MD; and John Doane, MD. Dr. Koch took the stance that preoperative IOL calculations are best, stating that they work on all patients, with no increase in surgeon or OR time. Dr. Wiley maintained that intraoperative aberrometry is best and provides an extra layer of confidence in calculations. Dr. Wiley also shared his prediction that the future of IOL calculations will involve an intersection of biometry, intraoperative aberrometry, and the ability to make postoperative adjustments. Rounding out the debate, Dr. Doane spoke in favor of the Light Adjustable Lens (Calhoun Vision), stating that this technology can be advantageous for any patient who desires spectacle independence.
New Technology
The “New Technologies” session presented a look at the ophthalmic marketplace and highlighted a range of innovative products in the pipeline. Leading off, Mr. Mazzo lead a discussion about what strategics are buying in the ophthalmic space. As he discussed, a majority of ophthalmic strategics are now competing for investment funds within their own organizations, creating an interesting environment. Next to take the podium was a venture capitalists tank consisting of Randy Alexander; Richard Baker; John Kilcoyne; and William Link, PhD, all of whom weighed in on a range of new technologies and treatments. Included were presentations onArcScan high-frequency ultrasound technology, the Zepto capsulotomy system (Mynosys), a Ziemer femtosecond laser scalpel, Diopsys electroretinography, the Harmoni Modular IOL (ClarVista Medical), Allotex corneal inlay and onlay technology, and the FluidVision accommodating IOL (PowerVision). After each presentation, the panel voted whether the technology was ready for prime time or if it was too early to tell, sharing suggestions for the products to achieve success.
Presbyopia Challenge
Rounding out the great debates, Jeffrey Machat, MD; Y. Ralph Chu, MD; and Robert Maloney, MD, weighed in on three inlays for the correction of presbyopia. First, Dr. Machat argued that a small-aperture inlay is best, citing his personal experience with the Kamra inlay (AcuFocus) and describing how having the device in his eye has helped him educate patients and validate the technology. Next, Dr. Chu discussed why a shape-changing inlay, the Raindrop (ReVision Optics), is best, noting that patients appreciate the device’s nonmedical name. Last, Dr. Maloney shared his thoughts on the merits of a refractive inlay, sharing positive results with the Presbia Microlens from studies conducted outside and in the United States.
More from AECOS
To watch video coverage of select talks from the AECOS Winter Symposium, visit http://eyetube.net/series/daily-coverage-aecos-aspen-2016/. AECOS looks forward to its annual European Symposium, taking place June 23 to 26; stay up to date on all meeting highlights on Twitter by following @AECOSurgery and using the hashtag #AECOSEurope.