ENDURING VALUES

How Do I See Cataract Surgery in 30 years?”

His flight would soon come to an end. In a few minutes’ time, his personal air taxi would land in London. He felt quite satisfied with his decision to watch the Congress in person, although most ophthalmologists at his age would prefer the virtual environment option the Society had implemented 10 years previously.

It is not every year that an anterior segment surgeon has the chance to commemorate Sir Harold Ridley’s great discovery and the LXVII annual Congress of the ESCRS, held in London to honour the pioneer of cataract surgery, was a great opportunity.

As he was approaching the landing spot, his thoughts went back to the first ESCRS Congress he had attended as a resident ophthalmologist, 35 years ago, also held in London.

A stunning experience for a young physician, reflecting, however, a completely different era in ophthalmology. He was grateful to have been a part of the breathtaking advances that had taken place in the last three decades in the fields of cataract and refractive surgery, redefining common beliefs and leading to better surgical results.

Holographic advertisements

The congress hall was decorated with holographic advertisements, depicting smiling patients in their mid-30s. New-era intraocular lenses (IOLs), capable of preserving accommodation, had changed cataract surgery drastically. Clear lens extraction was now the rule and young patients had the choice to correct refractive errors, preserving the integrity of their cornea and avoiding cataract completely.

Corneal refractive surgery was now reserved for a minority of patients. There was even a heated argument among Society members regarding its name, as many thought that ESLS (European Society of Lens Surgeons) was better related to their everyday practice, and a vote was to be held during the congress.

The exhibition room was impressive, with its central spots reserved by companies presenting their integrated, laser-assisted phacoemulsification devices. With the use of integrated systems, preoperative control and surgery were easily combined, with the patients remaining in a single position throughout the entire process.

Only a small part of the operation was still performed manually and uneventful operations seldom lasted more than a few minutes. The rate of complications was constantly declining.

Robotic Assistants

The question whether there was still a necessity for skilled surgeons kept troubling him, but he was comforted by the thought that challenging cases which rendered human surgical skill and experience necessary would always come up.

A robotic assistant offered him a synthetic refreshment, vaguely reminiscent of an orange juice, disrupting his thoughts. While he was strolling through the exhibition, he was amazed by the variety of custom made IOLs.

A multitude of companies was now offering IOLs especially designed and fabricated for each individual patient. Anterior segment surgeons were not only able to define the refractive power, but also the size and the coating of the lens.

Naturally, postoperative use of eye drops was dramatically reduced, as new generation IOLs eluted the necessary drugs for the desired period of time, overcoming all problems related to drop instillation. He had the chance to test some of them in virtual reality “wet labs” and the results were more than satisfactory.

Education had always been a vital part of the Society’s activities and, as expected, a special session was devoted to young surgeons’ new training methods. New-era simulators and technological advances led to a shorter learning curve, meaning that resident ophthalmologists were ready to perform unassisted surgery within a few months.

Training days

His thoughts went back to his training days and his first operations. He couldn’t help but feel a little envious of his young colleagues who avoided the stress he had to undergo while training, but he also recalled his feelings after a successful operation and this memory put a smile on his face.

The Orbis and Oxfam projects grabbed his attention with their impressive presentations of their work. With cataract becoming the primary reason of loss of sight in developing countries, these initiatives devoted a great share of their resources to its treatment.

Although state-of-the-art methods such as those presented in the Congress remained out of reach for developing countries, previous generation equipment provided a decent, cost-effective alternative and allowed thousands of patients to achieve a better quality of vision.

Supported by technological advances in the fields of communications and transportation, a great number of volunteers worked constantly towards improving global eye health. As he had expected, the Congress turned out to be a rewarding experience.

Indeed, a lot had changed in ophthalmology during the last decades and treatment of cataract was one of the fields that had undergone the most drastic changes, in terms of demographics, methods, equipment and training.

He felt grateful to have witnessed them. However, it was equally obvious that the values of the ophthalmological community had remained the same. Ophthalmologists around the world continued devoting their work, and often their life, to restoring their patients’ eyesight and, as a result, their quality of life. It was safe to predict that this effort would continue in the years to come.

* Dr Lampos Lamprogiannis is a resident ophthalmologist in the 4th Ophthalmology Department of AHEPA Hospital in Thessaloniki, Greece