ESCRS Congress, Amsterdam, October 2013 Report by Dr Clare O’Donnell

The XXXI European Society of Cataract and Refractive Surgeons (ESCRS) Congress took place at the RAI convention centre, Amsterdam on 5-9th October 2013.  This year a record number of more than 7,000 delegates attended from over 100 different countries.  The programme consisted of lectures, posters, videos, instructional courses, wet lab training and practice development sessions, including 17 symposia, more than 700 free papers and 800 electronic posters!  New interactive poster sessions were introduced this year, where the format was a one minute summary of posters by the session moderators, followed by the opportunity for authors to discuss their posters with the moderators and the audience.

On Friday prior to the meeting, the European Glaucoma Society organised its 3rd ESCRS Glaucoma Day.  Sessions included talks on the glaucoma burden, glaucoma risk factors and challenges to the use of IOP metrics, as well as the medical and surgical treatment of glaucoma.  This year’s ESCRS Congress was also held in association with the 4th EuCornea Congress and a sub-speciality day in Paediatric Ophthalmology organised by the World Society of Paediatric Ophthalmology & Strabismus and the European Paediatric Ophthalmological Society (EPOS). The European Society of Ophthalmic Nurses and Technicians (Esont) also had a programme of free papers, posters, symposia, instructional courses and wetlabs.   These events helped attract more delegates to the Amsterdam venue.

At the Opening Ceremony, the president of the ESCRS, Dr Peter Barry, welcomed delegates and emphasised the strong historical links between the Society and the Netherlands.  It was in 1982 when Dutch ophthalmologist Cornelius Binkhorst convened the first meeting of the European Intraocular Implant Council (EIIC), which later developed into the ESCRS.  Dr Barry reported that the Society returned to the Netherlands in 2001 with 2,300 delegates and said that he was ‘delighted’ that 12 years later the number of delegates has increased to over 7,000.

Dr Barry highlighted the Society’s initiatives for supporting research such as the ESCRS PREMED study (which is for the prevention of macular oedema after cataract surgery), a new femtosecond laser-assisted cataract surgery study and the EUREQUO patient outcomes register which now has the outcomes of almost two million cataract surgeries recorded in its database.  Dr Barry also informed delegates about the launch of the Endophthalmitis Registry, which he said is designed to identify changing patterns in the breakthrough of the bacteria causing this infection following surgery, and to follow changes in antibiotic resistance of the microorganisms.  Copies of the 2013 publication ‘ESCRS Guidelines for Prevention and Treatment of Endophthalmitis Following Cataract Surgery:  Data, Dilemmas and Conclusions’ was made freely available to delegates attending the Congress this year.   Copies of a publication entitled the ‘European Society of Cataract & Refractive Surgeons – A History’ was also available for attendees.  This book was edited by Emanuel Rosen and Peter Barry and offers a fascinating insight into how Sir Harold Ridley’s pioneering achievements have provided the inspiration for one of the most successful ophthalmological societies in the world today.

The Binkhorst Medal Lecture entitled ‘The ablated cornea: what have we done?’ was given by Douglas Koch during Sunday’s opening ceremony.    He presented current and future research related to how the cornea can change after excimer laser ablation.  His presentation discussed effects on corneal epithelial thickness, alterations in optical properties, including useful changes that can increase multifocality, and the changes in the relationship between the anterior and posterior corneal surfaces which can affect refractive predictability during intraocular lens surgery.    Dr Koch concluded by saying that whilst corneal ablation is a remarkably successful procedure, to build on the excellent outcomes already being achieved, there is a need to make further progress into understanding the induced changes more fully.

The Michael Blumenthal Award in the Video Competition went to Makoto Kishimoto, Japan, for an entertaining and informative futuristic presentation entitled “New type torsional phaco tip advantages”.  Dr Kishimoto described how a close examination of the physics of ultrasound phacoemulsification led to the design of a new phaco tip that is less likely to cause disruptions of flow and scattering of lens fragments.  In fitting with this year’s Congress venue, he described how experiments using pieces of Gouda cheese, inspired the design of the tip.

Jan Van Looveren, Belgium, received First Prize in the cataract poster competition for ‘Surprising immunohistochemistry of the vitreolenticular interface in developmental cataracts’.  The authors found that histological and immunohistochemical testing supported the theory that the opaque plaques found on the capsular tissue in such cases were the result of lens epithelial cells transforming into mesenchymal cells.  Young ophthalmologist Nicole Tsim won the 2013 John Henahan Prize for her essay on ‘Recollections of My First Intraocular Surgery’.

Figure 3 Caption: Jan Van Looveren (left), winner of the Cataract Category in the Poster Competition, with Peter Barry, president of the ESCRS. Image courtesy of the European Society of Cataract and Refractive Surgeons.

Under discussion at a joint ESCRS/EuCornea symposium was ‘Refractive surgery in risky corneas:  is it really safe for the patient?’  The symposium tackled topics such as the risk factors that should be considered and which patients should be avoided, enhanced corneal analysis technology to help define corneas at risk and ocular surface disease and laser refractive surgery.  Jose Guell, president of EuCornea discussed the management of complications after surgery in risky eyes.

Workshops on visual optics and imaging and free paper sessions on surface ablation, posterior capsular opacification and new evaluation tools presented delegates with a diverse range of topics on Sunday.   As in previous years the ESCRS Congress included a range of tantalising hot topics.  A well-attended session on femtosecond laser-assisted cataract surgery provided delegates with useful updates on this new, but expensive, technology that can be used to create precise corneal incisions, capsulotomies and to liquefy and fragment the crystalline lens.  The economic case for the technology was debated as well and clinical outcomes data presented.  Proponents claimed that this approach to intraocular lens surgery will lead to better self-sealing incisions, more accurate refractive and visual outcomes, less impact on corneal endothelial cells and faster visual recovery, although others remained to be convinced, arguing these claims have yet to be substantiated in the scientific literature.

Sessions on intraocular lens technology (toric, accommodative and multifocal IOL designs) were an essential component of the programme.   These included updates on visual and refractive outcomes with these devices, as well as tips for patient selection and optimising satisfaction levels.  Some authors presented data to suggest that reduced addition multifocal IOLs may provide useful near vision ability, whilst minimising the glare and halo effects associated with some designs.  Several authors presented data on trifocal IOLs which may provide improved intermediate and near vision ability compared to other options.

A session entitled ‘Refractive femtosecond’ presented data on corneal lenticule extraction surgery (ReLEx SMILE). This procedure involves the creation of a lenticule of corneal tissue with a femtosecond laser that is then removed through a small incision.  Advocates of this approach claim that it induces a change in the refractive power whilst minimising disruption to the superficial corneal layers and corneal nerves.

‘Unravelling the mysteries of myopia’ was another theme and highlights of this session included presentations on why eyes become myopic, orthokeratology and new approaches for the prevention of myopia.  Professor Donald Tan presented compelling data from the ATOM studies relating to the use of low-dose topical atropine to help control the progression of myopia in children.  Other presentations discussed the use of phakic IOLs in moderate and high myopia and clear lens extraction in high myopia.

Another thought provoking session that proved popular with attendees was on ‘Clear lens extraction:  Have we lost our way?’  This session considered motivations for performing this type of surgery, the long-term effects, indications and contra-indications as well as image quality with different IOL designs.  Sessions on the management of high hyperopia and astigmatism during intraocular lens surgery were also well attended, as were several dedicated sessions on presbyopia correction. The latter included presentations on presbyopic excimer laser treatments, multifocal intraocular lenses as well as intracorneal inlays for presbyopia.  A session on corneal biomechanics, chaired by Professor Cynthia Roberts considered the latest information on techniques for improving and evaluating corneal biomechanical properties.  Symposia addressing macular oedema, phakic IOLs and corneal stem cells were also  on offer and satellite educational programmes included IOLs for micro-incision cataract surgery (MICS) and laser applications for vitreolysis (disrupting vitreous floaters) and for treating glaucoma.

In the exhibition a vast array of the latest technologies for corneal laser refractive surgery and intraocular lens surgery were predictably on show along with the newest devices for refractive correction, ocular imaging, biometry and assessing and treating dry eye.

A great feature of this meeting is that members of ESCRS have full access to the presentation library ESCRS on Demand .  This is a useful feature since the extensive programme on offer means that it is impossible for delegates to attend every session.  ESCRS on Demand offers members the chance to view, at their leisure, the web-based scientific contact of all ESCRS Congresses.   All-in-all this was a fantastic meeting for anyone interested in cataract and refractive surgery.  In September 2014, the ESCRS Congress will be held in London and will be partnered with the EuCornea and EURETINA congresses. The organisers of next year’s meeting surely have a hard act to follow.