Lively ESCRS Programme

The first ESCRS Virtual Congress, the 38th Congress of the ESCRS, was broadcast from Friday 2 October to Sunday 4 October 2020.

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David F.Chang MD
The scientific programme was centred on four rooms streaming sessions across a wide range of topics with lively discussion interspersed throughout the programme. At the Opening Ceremony, the President of the ESCRS, Prof Rudy MMA Nuijts, welcomed delegates to the Congress before he invited David F. Chang, USA, to deliver the Ridley Medal Lecture. “I have long felt that our single greatest challenge in ocular surgery was not the invention of an accommodating IOL but rather the rapidly increasing backlog of cataract blindness in the developing world, which accounts for half of all global blindness,” said Dr Chang. (pull quote) Dr Chang's lecture focused on the Aravind Eye Care System in southern India, which has grown into the largest eye care provider in the world. Reflecting on his own association with Aravind, which dates back to 2003, Dr Chang, Clinical Professor at the University of California, San Francisco, said that there are many lessons to be learnt from the Aravind model of providing large-volume, high-quality and affordable care through its network of 13 eye hospitals and 75 primary eye care facilities. Aravind’s unique assembly-line approach, with rates often exceeding 14-to-16 cases per hour per surgeon, increases productivity but without compromising on safety or quality, said Dr Chang. Every patient receives the same high-quality care and service, regardless of their economic status, he said. “When I first saw this, I marvelled at how well choreographed it all was. Around 40% of private paying patients subsidise eye care for the other 60%, who receive services either free of cost or at a steeply subsidised rate, yet the organisation remains financially self-sustainable. The message is that we can use this type of cost-recovery model to reduce and eventually eliminate global cataract blindness,” said Dr Chang. On the opening day of the programme delegates also heard a presentation from Prof Marcel Levi MD, Chief Executive of University College London. Hospitals, UK, on "Tackling the COVID-19 crisis: professionals in the lead". Prof Levi noted that there was massive redeployment of medical staff during the first wave of the pandemic in many countries, to deal with patients who contracted the virus and to protect other patients and staff, which proved very challenging for many healthcare workers. “We are now extremely subspecialised. We know very well how to do our jobs but it is very difficult to do someone else’s job,” (pull quote) he said, adding that in older patients presenting with many comorbidities this is a real challenge. ARTIFICIAL INTELLIGENCE One of the highlights of the second day of the programme was the Clinical Research Symposium on "Artificial Intelligence". Béatrice Cochener-Lamard MD, PhD, outlined the development of AI in ophthalmology and the role of deep learning to assist in diagnosis, citing its successful use in diabetic retinopathy. Looking at the latest developments, she said we are now well on the road to automatic image classification and that the use of AI will become a widespread tool in all imaging modalities (2D and 3D and beyond). Thanks to the creation of more refined algorithms, the use of ‘big data’ is not always necessary now and there are “multiple additional applications” that are on the way. These include using AI as an integrated part of “screening, diagnosis, decision support and maybe even surgical help”. “So, the future looks very exciting to help ophthalmologists for sure, but never to replace us,” (pull quote) Prof Cochener-Lamard concluded. The ESCRS and EURETINA held a combined online symposium entitled “Cataract Surgery in Patients with AMD”, chaired by Nic Reus MD, PhD, and Carel Hoyng MD. The symposium covered crucial topics intended to help the surgeon’s decision-making process before, during and after cataract surgery in patients with age-related macular degeneration (AMD). Dr Hoyng opened the symposium with an overview of the differential diagnosis of AMD. His presentation zoomed in on five important macular diseases that can closely mimic AMD. These monogenetic diseases, such as late-onset Stargardt disease and pattern dystrophy, might represent up to 10% of cases diagnosed as AMD. “You should suspect a retinal dystrophy in patients with an early age of onset, a positive family history, marked lesion symmetry and foveal sparing,” said Dr Hoyng. EXPECT THE UNEXPECTED In the Main Symposium "What To Do When The Unexpected Happens", delegates were told that "Expect The Unexpected” should be the guiding mantra of every cataract surgeon who presumes that each procedure will inevitably proceed in a smooth and controlled manner. "The only surgeon who doesn’t encounter complications is one who doesn’t operate at all. (pull quote) The overall message is not to panic when things go wrong and to realise that there are possible solutions,” said David Spalton, MD, FRCS. Despite all the advances in technology and surgical techniques, post-cataract surgery visual issues persist in some patients and must be dealt with honestly and practically while continuously striving to improve outcomes. This was the key message for delegates watching the “20/20 in 2020: The Lens” Main Symposium. Scott MacRae MD highlighted the success of early studies on novel femtosecond laser-induced refractive index change for IOL touch-ups, which, he explained, is biocompatible, relatively non-invasive and can treat refractive error, presbyopia and high-order aberrations. “We are very, very excited about this technology and look forward to presenting more information in the future,” said Dr MacRae. HERITAGE LECTURE The highlight of Sunday's programme was the 2020 ESCRS Heritage Lecture delivered by Theo Seiler MD, PhD. In his talk, Prof Seiler discussed the overlap between LVC and cataract surgery and the difficulty of obtaining consistently predictable refractive outcomes now that the first-generation of LVC patients has reached cataract age. The early history of laser vision correction (LVC) was a far cry from the high-tech technological precision that refractive surgeons today take for granted, said Prof Seiler. “The first PRK surgeries that I performed were quite rudimentary by modern standards. The eye tracking and the IOL centration were performed using only my hands and my eyes so you can imagine that safety suffered accordingly," he said. Turning to modern cataract surgery, Prof Seiler noted that while significant improvements have been achieved in IOL power calculations due to advances in optical biometry, there is still considerable inaccuracy when it comes to keratometry measurements for post-LVC eyes. “Studies have shown that despite better preoperative diagnostics that the chance of postoperative refractive surprise is still greater than 20%,” he said. YOUNG OPHTHALMOLOGISTS PROGRAMME Another highlight on Sunday was the Young Ophthalmologists Programme. When performing cataract surgery “capsulorhexis should be continuous, curvilinear and it should overlap the optic 360 degrees,” said Nic Reus MD, Netherlands, at the "Starting Phaco" session “This is to reduce incidence of PCO [posterior capsule opacification] and to get a stable lens inside the bag, which is helpful for refraction,” he said. To ensure a continuous curvilinear capsulorhexis, he said, the surgeon should make a mental note of the size of the circle they want to make, and follow that imaginary line. During his practical presentation, Dr Reus demonstrated the three different incisions that can be used; single-plane corneal incision, biplanar, and three-step scleral incision. When entering the anterior chamber, the most stable incisions are square (not too short and not too long), he said. Regarding hydrodissection, Dr Reus advised looking out for both the anterior wave and the posterior wave. SOCIAL PROGRAMME In his address to delegates at the Opening Ceremony, the President of the ESCRS Professor Rudy MMA Nuijts had stressed the importance of the virtual social programme for delegates. On Friday night October 2, Lucas & Steve, Europe’s most uplifting DJs, played an exclusive gig for ESCRS 2020 delegates. The duo hail from Maastricht, home of Prof Nuijts. Tapping into the rich history of dance music in the Netherlands, Lucas & Steve explored glorious melodies and emotive sounds in their music, On the Saturday night, there was another musical treat for delegates when the world-famous Royal Concertgebouw Orchestra played a special concert featuring the music of the renowned American composer George Gershwin. The orchestra was founded in 1888 and on the occasion of its 100th anniversary in 1988, the orchestra officially received the appellation ‘Royal’ from Her Majesty the Queen, Beatrix Of the Netherlands. The orchestra is based in Amsterdam, and has been acclaimed as one of the very best orchestras in the world, as ESCRS delegates will have discovered. CONCLUSION And so, the ESCRS Congress is over for another year. As Prof Nuijts said in his closing remarks: “We will meet again next year and this time hopefully in person. Although this meeting was, I think, a tremendous success as a virtual meeting, this can never replace the charm of a physical meeting. So please stay safe, stay healthy, and thank you very much for your support,” he said.
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