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& cataract • anterior segment • kudos • enlightenment

11 | 13 | 20 posterior segment • innovation • enlightenment

C A K E A N D P I E M A G A Z I N E S ’ D A I LY C O N G R E S S N E W S O N T H E A N T E R I O R A N D P O S T E R I O R S E G M E N T S

HIGHLIGHTS segment 04 Anterior surgeons, check out some clinical pearls... “customizing 06 Yes, corneas” is a thing... find out more. you need a 08 Maybe YouTube Channel for your ophthalmic videos? See how you can set up one.

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Andrew Sweeney Elisa DeMartino Hazlin Hassan Olawale Salami Sam McCommon Maricel Salvador Graphic Designer

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G

ood news everyone! While the world continues to react to the announcement of a potential coronavirus vaccine that is up to 90% effective, we can perhaps start daring to dream that the pandemic’s end is in sight. While we continue to watch with bated breath and hope this potential Pfizer vaccine will work, there is yet more good news still. The last big conference of the ophthalmological year is upon us! The American Academy of Ophthalmology (AAO) annual meeting is about to take place and the ophthalmology community is abuzz with excitement. Scheduled to have been held in Las Vegas, Nevada, this year’s event is online of course, but that likely won’t stop the AAO from putting on a show for us all. There will be 100 hours of scheduled live broadcasting and up to 700 hours of additional content for you to consume at your leisure. The AAO 2020 Virtual conference will run from Friday, November 13 to Sunday, November 15, and starts on each day at 07:30am, running until 4:00pm (Pacific Standard Time). This will give you plenty of time to consume as much awesome

ophthalmology content as possible. You can even keep the spirit of Las Vegas going by playing blackjack in the breaks between each session, or maybe dress up Cont. on Page 3 >>

DEFINITION

Retina Rita* noun

A physically alcoholic (yet virtually nonalcoholic) margarita shared digitally with retina specialists attending a virtual conference. *Shared by Dr. Nina Berrocal during the Alcon Retina Film Festival Virtual alongside AAO. *New virtual conference definitions, by Media MICE


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13 Nov 2020 | Issue #1

Chec OCT k Diana resu lts.

OZURDEX® has multiple modes of action,1–3 a low treatment burden4–7 and a manageable safety profile.6–8

TRY DIFFERENT LETTERS IN YOUR PRESCRIPTION FOR DME

DME, diabetic macular edema; OCT, optical coherence tomography. 1. Nehmé A and Edelman J. Invest Ophthalmol Vis Sci 2008;49(5):2030–2038. 2. Holekamp N. The role of corticosteroid implants in DME. Available at: http://retinatoday.com/2015/04/ the-role-of-corticosteroid-implants-in-dme. Accessed March 2020. 3. Campochiario PA et al. Am J Ophthalmol 2016;168:13–23. 4. Malclès A et al. Retina 2017;37(4):753–760. 5. Matonti F et al. Eur J Ophthamol 2016;26(5):454–459. 6. Aknin I and Melki L. Ophthalmolgica 2016;235:187–188. 7. Allergan. OZURDEX®. Summary of Product Characteristics. October 2019. 8. Boyer SB et al. Ophthalmology 2014;121(10):1904–1914.

INDICATIONS & USAGE: OZURDEX® contains a corticosteroid indicated for the treatment of macular edema following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO), for the treatment of non-infectious uveitis affecting the posterior segment of the eye, and for the treatment of patients with visual impairment due to diabetic macular edema (DME) who are pseudophakic or who are considered insufficiently responsive to, or unsuitable for non-corticosteroid therapy. DOSAGE & ADMINISTRATION: For ophthalmic intravitreal injection only. The intravitreal injection procedure should be carried out under controlled aseptic conditions. Following the intravitreal injection, patients should be monitored for elevation in intraocular pressure and for endophthalmitis. DOSAGE FORMS & STRENGTHS: Intravitreal implant containing dexamethasone 0.7 mg in the NOVADUR™ solid polymer

drug delivery system. CONTRAINDICATIONS: Ocular or periocular infections. Advanced glaucoma. Aphakic eyes with ruptured posterior lens capsule. Eyes with ACIOL, iris or transscleral fixated IOLs and rupture of the posterior lens capsule. Hypersensitivity. WARNINGS AND PRECAUTIONS: Intravitreal injections have been associated with endophthalmitis, eye inflammation, increased intraocular pressure, retinal detachments, and implant migration into the anterior chamber. Patients should be monitored following the injection. Patients who has a tear in the posterior lens capsule (e.g., due to cataract surgery), or who had an iris opening to the vitreous cavity (e.g., due to iridectomy) are at risk of implant migration into the anterior chamber. Use of corticosteroids may produce posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and may enhance establishment of secondary ocular infections due to bacteria, fungi,

or virus. Corticosteroids should be used cautiously in patients with a history of ocular herpes simplex. ADVERSE REACTIONS: In controlled studies, the most common adverse reactions reported by 20–70% of patients were cataract, increased intraocular pressure and conjunctival haemorrhage. Licenses may vary by country, please consult your local Summary of Product Characteristics. Adverse events should be reported to your Ministry of Health and local Allergan office. Date of preparation: March 2020 INT-OZU-2050060 OZURDEX® is not licensed for use in DME in China.


CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

>> Cont. from Page 1

as Elvis Presley. Just kidding, the choice is yours…

for and Recover from Disasters Affecting Your Practice, chaired by Dr. Cathleen M. McCabe.

Can’t help falling in love (with All shook up ophthalmology) Day one will kick off with an address from the leadership of the AAO and recognition of the Straatsma award winner, Dr. R. Michael Siatkowski, as well as the AAO’s guests of honor for 2020. This year, these august participants are Dr. Bartley J. Mondino, Dr. Bradley R. Straatsma and Dr. M. Roy Wilson. Friday will also host a number of subspeciality meetings on the following subjects. From 07:40am to 11:30am the following sessions will run; Glaucoma Subspecialty Day 2020: Winning Bets: Strategies in Glaucoma Care; Pediatric Ophthalmology Subspecialty Day 2020: The Only Game in Town; Refractive Surgery Subspecialty Day 2020: Celebrating 2020; Retina Subspecialty Day 2020: Vision for the Future and Uveitis Subspecialty Day 2020: Beating the Odds—How to Make Sure You Get a Full House When You’re Dealt Uveitis. From 12:30pm to 4:20pm the following sessions will run; Cornea Subspecialty Day 2020: Seeing Clearly Into the Future; Ocular Oncology and Pathology Subspecialty Day 2020: Collaboration Now More Than Ever; Oculofacial Plastic Surgery Subspecialty Day 2020: Back to the Basics with Tips and Tricks; Retina Subspecialty Day 2020: Vision for the Future.

While the CAKE & PIE team is excited for the entirety of AAO Virtual 2020, Sunday promises to be a particularly riveting experience. For starters, the new president of the AAO, Dr. Tamara R. Fountain, will be officially welcomed. She will be followed by What are Psychiatrists Seeing: Impact of COVID 19 on Physicians & their Communities, led by Dr. David W. Parke II, MD, and Dr. Saul Levin. The rest of the day takes on a distinctly Las Vegas tone of presentation and showmanship, with renowned journalist, writer and cultural observer Malcolm Gladwell interviewing Dr. Stephen McLeod. The doctor is editor-in-chief of Ophthalmology, the official journal of the American Academy of Ophthalmology, and the Chair of the Department of Ophthalmology at the University of California, San Francisco. This promises to be a highly engaging discussion. True magic will then take place when superstar magician and public intellectual Pen Jillette appears on the

virtual stage. Jillette will speak as part of the Michael F. Marmor Lecture in Ophthalmology and the Arts. Most well known as part of the Penn & Teller duo, Jillette is an actor, musician, inventor, television presenter, host of the Penn’s Sunday School podcast and two time New York Times best selling author.

Rubberneckin’ The AAO 2020 Virtual will also feature all your usual conference favorites including e-posters, original papers and educational videos covering everything from cataract and anterior segment highlights, to retina and uveitis abstracts. The CAKE & PIE team will be there throughout the whole weekend to keep you well informed about every aspect of the conference. Nothing, not typhoons or curfews, pandemics or technical problems, can stop us sharing our love of ophthalmology. So make sure you sign up, log in, and enjoy yourself when AAO 2020 Virtual begins this Friday. If you want to download a pdf of a more detailed schedule of all three days of the conference, you can find it on the AAO’s website. You can also visit the AAO’s virtual meeting guide to take a sneak peek at some of the content that will be displayed during the conference.

A little (more) conversation... On Saturday, Dr. Michael X. Repka will give a talk entitled Amblyopia Outcomes through Clinical Trials and Practice Measurement: Room for Improvement. Dr. Repka is the David L. Guyton, MD, and Feduniak Family Professor of Ophthalmology at the Johns Hopkins University School of Medicine, Wilmer Eye Institute. His address will be made as part of the Jackson Memorial Lecture series. Two general sessions will also take place on Saturday. These are Imaging Across the Eye: Updates in Ophthalmic Imaging 2020, chaired by Dr. Anthony N. Kuo, and Lessons Learned: How to Prepare

We’re caught in a (coronavirus) trap…I can’t walk out…

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13 Nov 2020 | Issue #1

Pearls in Anterior Segment Surgery by Brooke Herron

movement of the iris. It’s now a nice, stable, fairly routine cataract.” Dr. Ayres said this takes a case that would be challenging at baseline, but by placing the iris hooks, you can continue and complete it as any other cataract surgery.

Capsular instability: Hooks can be cut

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rior to the start of the annual meeting of the American Academy of Ophthalmology (AAO 2020 Virtual), a number of “on demand” sessions were made available to delegates. Pearl Jam: High-Impact, No-Nonsense Pearls for the Anterior Segment Surgeon was one such session, with Dr. Brandon Ayres from Wills Eye Hospital in Pennsylvania, USA, as one presenter. During the session, he reviewed patient cases and provided helpful tips to avoid and/or navigate tricky procedures.

Iris retropulsion syndrome: Place iris hooks To begin, Dr. Ayres presented a case of iris retropulsion syndrome. “This was already challenging surgery, with high myopia, a deep chamber and fairly significant cataract,” he shared.

Next, Dr. Ayres revealed another pearl for use in cases of zonulopathy. “I’ve heard from a lot of people that you use a flexible iris retractor as a capsular stability device,” he said. “However, the hooks don’t really reach the lens equator — and that’s where you need the support when you’re dealing with a zonulopathy.” He continued that although a flexible iris retractor may hold the capsulorhexis in place, they don’t reach the equator where the problem is — rather they hold the rhexis. “So, when you go in with your phaco tip or IA, you can still draw the equator of the lens to you, causing problems and progressive zonulopathy,” said Dr. Ayres. “A true iris support hook is going to reach all the way out to the equator so it holds it in place; you can do your cataract, you can do your IA and not cause problems.”

Intraoperatively, in these cases, the lens/ iris diaphragm is constantly moving and dilating; the anterior chamber is getting deeper and shallower; and usually the patient is starting to feel that pressure and they really don’t like it, he continued.

He then described a case of a patient with a traumatic cataract and known zonulopathy. In this instance, he shared that luckily, he was able to make the capsulorhexis, however he noted that in some cases it can be impossible to make the rhexis because the zonulopathy is so bad.

“A very simple fix is to elevate the iris with a single, flexible iris retractor,” said Dr. Ayres. “All we’re doing is picking up on that nasal iris a little bit . . . and suddenly the chops are beginning to work, the anterior chamber becomes much more stable, we’re not getting the

“We put in our flexible iris retractors, wherever the zonulopathy is. Sometimes it’s global and we have to use four or even five of these hooks; sometimes it’s just regional, so we’re just putting the hooks where they need to be,” he continued.

“A nice little tip is that you can cut these hooks — especially on the nasal side as you’re moving the eye during the surgery. Sometimes those ends of the hooks get stuck on the drape, on your instrument, or on the lid speculum. So here, make sure you trim them back, it just makes things much easier,” said Dr. Ayres. To do so, he advised using the back of Westcott scissors. “These are not meant to be trimmed and it’s off-label use,” he cautioned. “But the back of the Westcott is usually the sharpest spot and you can trim them down, so they’re no longer bouncing around and wreaking havoc on the inside of the eye. They’re only holding the capsule in place.”

Capsular tension rings: Use an IOL positioner and 10-0 sutures “There’s nothing more confusing than asking for a capsular tension ring (CTR) when you’re not used to using them, and then the scrub tech or the nurse says, ‘what size CTR do you want?’ “Truth be told, most of the time it doesn’t matter what size CTR you use: The larger the eye the larger the CTR, but there’s nothing wrong with a CTR overlapping itself and adding additional support, so I usually just ask for the biggest CTR they can find,” shared Dr. Ayres. He says placing CTRs can be challenging in some cases — the CTR needs to land softly in the eye. To do so, Dr. Ayres recommends using an IOL positioner: “You can put the little nub in the hole of the CTR, and this allows us to begin inserting the CTR — you get a lot of it inserted before it finally opens and lands in the equator. Then we can continue pushing the CTR into position.” If resistance is noticed, or if the CTR begins to kink at the equator of the eye, Dr. Ayres then suggests putting a 10-0 nylon suture and lace it through the eyelid of the CTR. “This will allow you to prebend the CTR and allow it to land softly. It also allows you to remove the CTR if at the end of the surgery if you decide you’re not going to use the capsular bag; in the case that you want to remove the CTR and not worry about it dropping into the vitreous. So, having that leash is very helpful.”


CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

Ocular and Gut Microbial Dysbiosis in Ocular Infections and Inflammation The Jones/Smolin Lecture: Drugs, Bugs and Antibiotic Resistance by Olawale Salami

At the 2020 edition of the Jones/ Smolin Lecture of the American Academy of Ophthalmology (AAO) annual meeting, Dr. Thuy A. Doan, an associate professor of ophthalmology at the Francis I. Proctor Foundation for Research in Ophthalmology (California, USA), showcased the work of her team of researchers in unraveling the effects of commonly used antibiotics on microbial communities in the eye and gut, and how these interactions may affect ocular health and lead to antibiotic resistance.

Setting the stage Dr. Doan explained the increasing global use of azithromycin. “As of 2020, approximately one billion doses of azithromycin were distributed for trachoma control programs globally,” noted Dr. Doan. Furthermore, there is emerging evidence that the mass distribution of azithromycin leads to improvement in childhood survival. “To add to these, azithromycin has become one of the most prescribed antibiotics in the United States and the most widely used antibiotic worldwide in patients undergoing treatment for COVID-19,” she added. The evidence of a significant reduction in childhood mortality following azithromycin’s mass administration for trachoma has spurred several clusterrandomized studies. Dr. Doan said that a project like the MORDOR project in SubSaharan Africa aimed to replicate these findings on a larger scale. Following community level randomization and treatment, ocular surface, throat, and rectal swabs were subsequently collected from children in these communities and sequenced to assess changes in the microbiomes and track emergence of antibiotic resistance.

It’s all in the gut “Given that the gut is the largest reservoir of microbial communities in the human body, we first looked at the gut microbiome,” explained Dr. Doan. Her team collected ten samples per village for RNA deep sequencing to evaluate the gut microbiome. “The result from our analysis of the gut microbiome showed that azithromycin treatment at 24 months led to a reduction in campylobacter species in the gut. These findings are similar to those from studies performed in similar settings in other parts of Sub-Saharan Africa, confirming that indeed, azithromycin can lead to a reduction in gut carriage of campylobacter,” she said.

Azithromycin’s effects on ocular microbiota: More than meets the eye Given the impact of oral azithromycin on gut bacteria, Dr. Doan and her team sought to understand if similar changes were happening in the eye. “To evaluate this, we performed RNA sequencing on pooled conjunctival samples from randomized children. We found that azithromycin treatment altered the ocular microbiome structure, with a resultant increase in diversity,” she shared.

Can antibiotic resistance emerge from mass drug administration for trachoma? A significant concern of the mass administration of antimicrobials is the possibility of selection of resistant strains. Dr. Doan and colleagues evaluated antibiotic resistance in Streptococcus Pneumoniae isolated from children’s throat swab samples and from gut bacteria to address this concern. “After 24 months, we found an increase in the prevalence of macrolide resistance determinants in children’s gut from villages randomized to the azithromycin treatment arm. However, we were unable to detect resistance to other classes of antibiotics,” reported Dr. Doan. “Mass azithromycin administration’s effects are long-lasting, and we know that alterations in the ocular surface microbiota composition and diversity are significant,” she added.

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13 Nov 2020 | Issue #1

Asterix?

That’s Right, and Crazy Good Corneal Customization by Andrew Sweeney

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o I’m going to start off this article by stating that a new bar has been raised in ophthalmology. Truly, the community has reached a new peak of ingenuity, creativity and original thinking when it comes to refractive surgery. I am not talking about a novel new surgical technique or treatment, I’m talking about something far more profound. Creating a cartoon specifically for a video presentation at an ophthalmological conference. Yes, although the American Academy of Ophthalmology (AAO) 2020 Virtual is only kicking off, the bar of bars has been raised higher than ever. A Novel Toolkit for Customization of Cornea in Post–Refractive Surgery Eyes Undergoing Cataract Surgery features none other than Asterix and Obelix. Authored by Dr. Sriram Annavajjhala, Rohit Shetty and Dr. Mathew Kurian Kaweri, this Indian video with the aforementioned Gallic flair examines post–refractive surgery eyes with irregular corneas exhibiting disturbing symptoms, like glare and halos. The researchers aimed to demonstrate an algorithmic approach to treat these corneal imperfections using corneal tomography and ray tracing aberrometry prior to cataract surgery. They reported that by using a customized approach they saw improvement in both the uncorrected and best corrected visual acuities for all patients involved, along with improved visual quality.

The wise men of the woods will know Truthfully, there does not appear to be a clear reason for Asterix and Obelix appearing in the video, but who cares, because it is awesome. The video quality is remarkably high, beginning with an outline of the history of laser surgery. The main case study of the video, a 54-year-old male who underwent LASIK

surgery 20 years ago, was emotionally and profoundly played by Asterix (the skinny one of the duo). The subject reported blurring of vision and constant glare, causing distress and diminished quality of life. The subject then consulted the council of druids (according to the video…) for treatment. The answer to improve patient outcomes is ‘surface regularization of irregular corneas before cataract surgery ensures more predictable intraocular lens power calculation and reduces the chances of refractive surprises post surgery.’ An algorithm can be used to ensure this, the C3 algorithm, which means corneal, customization cataract surgery. The video then reports on how to use wavelight topography ablation treatment software to implement this algorithm for surgical treatment. The video then provides a detailed explanation of the correct formulae required to find the best treatment for each patient.

What’s the Gallic for intraocular? Returning back to the council of druids, who appear very knowledgeable despite not having studied ophthalmology at university, the video considers the best IOL type to be used. An aspheric IOL was recommended, depending on the type of ablation. A positive spherical aberration IOL was recommended for uses in cases involving hyperopic laser ablation, whereas a negative spherical

aberration IOL was recommended for myopic laser ablation. In the case of the aforementioned 54-year-old male, a negative spherical aberration IOL was implanted at a diopter of 18+. The patent subsequently reported best visual acuity of 20/20 after surgery. Overall, the researchers concluded that in case of a regular cornea, the IOL should be based on spherical aberration, whereas in irregular corneas, topography-guided custom ablation should be applied first. As always, kudos for the high quality research, and particular kudos for the guest appearance of the Gauls! We can only hope that more videos will feature some of our cartoon friends in future. Sound the metaphorical beacon friends, the bar has been raised.

Editor’s Note: The writer is Scottish and loves the ophthalmology subject matter. “Deadly” combination.


CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

New Insights into the Treatment of Retinoblastoma Highlights from the AAO 2020 Zimmerman Lecture by Olawale Salami

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r. Patricia Chevez-Barrios is a professor of ophthalmology, pathology and laboratory medicine at Cornell University, and chair of ophthalmology at the Houston Methodist Hospital. For over 2 decades, she has led a team of scientists whose work has improved our understanding of retinoblastoma. She gave the 2020 Zimmerman Lecture at the annual meeting of the American Academy of Ophthalmology (AAO 2020 Virtual), where she chronicled her pioneering work. Retinoblastoma remains the world’s most common primary ocular tumor, and about 8,000 new cases are diagnosed worldwide every year. Most cases are diagnosed in children under 4 years of age, and the majority of these tumors are linked with the RB-1 gene mutation. “We see that about 3,000 children die every year of retinoblastoma, mostly in Africa and Asia, mainly because of late diagnosis,” highlighted Dr. ChevezBarrios. In other cases, the clinical presentation is atypical, and these cases are wrongly diagnosed as uveitis or Coat’s disease. “We know that when the tumour escapes the eye to the brain, the disease is invariably fatal, she said.

Suicide gene therapy to the rescue Dr. Chevez-Barrios and colleagues started the first set of retinoblastoma clinical trials in the late 1990s, and, according to her: “At that time, we were aiming for localized treatment and trying to evaluate suicide-gene therapy. We selected patients who had vitreous seeding because they had high rates of recurrence and were difficult to treat.”

Suicide gene therapy is based on a construct that has an adenovirus as a promoter with a thymidine kinase gene incorporated. “Once cells receive this gene, they start producing thymidine kinase, which then phosphorylates ganciclovir, which blocks DNA replication and causes tumor cell death,” explained Dr. Chevez-Barrios.

Injecting an eye tumor: Making history The next hurdle was to deliver gene therapy into the tumors safely. “We showed that suicide gene therapy works in animal models of retinoblastoma; therefore, the next step for us was to do this in humans safely. We explored the option of using fine-needle aspiration biopsy technique to inject our treatment into the tumor cells and reviewed current literature on the risks associated with tumor injection,” shared Dr. ChevezBarrios. She added that they were not worried because, from the experience of other experts who have used fine needle ( 25-30G needles) aspiration on tumors, fine needle aspiration is associated with a low risk of spreading the tumor cells. “We chose the smallest possible needle size, avoiding vascularized tissue and taking additional precaution to sterilize the needle tract using cryotherapy and copious irrigation,” she said. However, not everyone was convinced about this technique. “During those early days, we experienced significant push backs from the ethics committees and the U.S. FDA regarding the safety of our technique because this was the first attempt to inject retinoblastoma tumour,” shared Dr. Chevez-Barrios.

Saving lives, saving eyes “Our results demonstrated for the first time that gene therapy could be safely administered into the eye. Overall we treated the first 8 patients, and there was no spread of the tumor outside the eye or along the needle tract,” noted Dr. Chevez-Barrios. And this was only the beginning. According to Dr. Chevez-Barrios, in 2005 she and her team designed the first-ever prospective clinical trials of retinoblastoma treatment. “In this multicountry study, we enrolled 321 eligible patients from 2005 to 2010, and we evaluated the role of chemotherapy in preventing recurrences in children with unilateral retinoblastomas without high-risk histopathologic features,” she shared. The early results were unexpected. “We were able to demonstrate the importance of histopathologic scoring. With these findings, our work has led to the increased use of gene therapy in retinoblastoma. Besides, we demonstrated high-risk groups for CNS recurrence with others to develop international guidelines for the pathology of retinoblastoma eyes,” said Dr. ChevezBarrios.

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13 Nov 2020 | Issue #1

YouTube for Ophthalmology Videos A Smart Choice I

f you’ve been anywhere near the internet in the last several years you may have noticed that it has become much more competitive. That statement holds doubly true if you have a business and try to rank your website as high as possible on search results to get better traffic. Simply put, better traffic leads to more business. If it’s easy for potential patients to find you online, you’re at a significant advantage to competitors who lag in the online world. And while talks of Google and SEO dominate this field, Dr. Randall Wong presented another suggestion to doctors at the AAO 2020 Virtual. That suggestion? Start a YouTube channel. He’s dead right: Starting a YouTube channel is a safe way to expand your business, assuming you already have a quality website. Best of all, it costs you little more than some time. So follow along as we navigate the wisdom Dr. Wong presented in the ‘on demand’ video section. There’s lots to glean, and it may be the boost your business needs.

Wait — Why YouTube? Your first question is probably something along the lines of, “Why should I start a YouTube channel?” It’s a valid question, and one we can answer. YouTube is the world’s second biggest search engine after Google. Forget about Bing, DuckDuckGo, or anything else. Google is #1 and YouTube is #2. And yes, Google owns YouTube. A similar analogy would be that the world’s

by Sam McCommon

largest air force is the US Air Force. The world’s second largest air force is the US Navy. YouTube appeals to people who learn differently than simply by reading text, the backbone of SEO marketing. Unsurprisingly, YouTube appeals most to people who learn visually or auditorily, which makes up a significant part of the population. Simply put, you’ll get more potential viewers. Dr. Wong’s own channel is a fine example of this. In his roughly ten years on the platform, he has garnered 1.3 million views from 65 videos. He has 4,270 subscribers and his channel focuses on retina surgery. Recall that YouTube isn’t solely used for entertainment. Plenty of people use it as a prime educational source, and it indeed can be. Dr. Wong’s own channel is a testament to that, as are many other similar pages.

Where to even start? While the concept of making a YouTube channel may appear daunting, it’s far easier than it


CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

may first appear. What’s best is that it likely requires no fancy hardware you don’t already have. Most certainly, you don’t need to hire a professional studio to make your own videos. That’s part of the whole appeal of the platform. If you have a modern laptop with a webcam, a relatively new smartphone, and some basic — often free — video editing software you’re good to go. Really, that’s it. You can make magic with what you already have. If you like bulleted lists — and who doesn’t? — here are the basics you need. • A video capturing tool (smartphone, webcam) • Video editing software (iMovie, Screenflow, countless others)

minutes, simply break the video up into different parts and label them as such.

• A Gmail account

Third, when creating content, recall that you can use multiple formats within your videos. You can make surgical videos, publish didactic lectures, or even present a webinar. There’s no limit, though recall that you may need to get past YouTube’s gore filter on their algorithm if you’re publishing surgical videos.

That’s it. That’s all you need to start a YouTube account and start making videos. Not bad, right?

YouTube Video Tips Of course, setting up an account just leads to a “what next?” question. Don’t worry — Dr. Wong has excellent advice there, too. First, recall that part of the reason behind the platform’s appeal is that people on YouTube want and expect to see transparent videos with minimal production value. The rawness adds to the honesty of the platform, which many — especially potential patients or peers wanting to learn something — will appreciate. ‘Rough around the edges’ is not a problem on YouTube. That means you don’t have to waste your time and money on expensive production. Hooray! Second, keep your videos short. People on the internet have a notoriously short attention span, so Dr. Wong recommends keeping videos to under ten minutes. If you have a procedure or a topic that requires more than ten

Fourth, don’t spend outrageous money on video editing software. There are plenty of cheap or free editing tools out there that a quick search on Google will find you. You certainly don’t need to blow hundreds or thousands of dollars on professional editing software.

Details, details When publishing your video, keep a few things in mind. • Keeping a standard format for your videos can help viewers know what to expect. • Publish regularly to retain your audience. • Make sure your title uses keywords you think people on YouTube will search for.

• Make sure your description is as detailed as possible and use as many keywords in it (in context) as you can. If you need, consult a free or cheap keyword research tool. • You can choose an eye catching thumbnail for the video or YouTube will do it automatically. Dr. Wong indicates this doesn’t matter so much. • Don’t worry about monetization if you’re trying to educate or build your authority. Your monetization will happen in the clinic.

Go forth, ye new YouTuber Making a YouTube channel can help increase your authority on a topic, get you access to new audiences, and may even give you a creative outlet. In the best case scenario, your channel becomes one of the most viewed in your field and you become a mini-star in the online world. Worst case scenario, absolutely nothing happens, you’re embarrassed, and you de-list your videos. You’re not even out any money. We highly endorse Dr. Wong’s views and commend him for bringing this to the attention of AAO attendees. We hope you enjoy the show as much as we’re expecting to!

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13 Nov 2020 | Issue #1

AAO 2020 Exhibitor Showcase Reporting on the newest products and launches from ophthalmology’s leading companies by Brooke Herron foundation of the immune system) using targeted C3 therapies.

Apellis: A Leader in C3 Therapies for GA Apellis describes itself as a company that is “committed to boldly developing transformative therapies for people living with geographic atrophy (GA),” a chronic, progressive and irreversible condition. The company is developing a treatment that harnesses the body’s complement system (which is the

APAO 2021 is Coming Mark your calendars! The Asia-Pacific Academy of Ophthalmology (APAO) is Asia’s leading ophthalmic congress and is here to share details for its next inperson congress. “On behalf of all Malaysian ophthalmologists, I’m delighted to welcome you to Malaysia for the 36th APAO Congress 2021,” said Dr. Kenneth Fong, president of the Malaysian Society of Ophthalmology. “It’s been

When complement activation is regulated, the body protects itself against immune attack. However, when it’s compromised, it can lead to inflammation and inappropriate cell destruction. It’s been found that complement hyperactivity causes overactivation of the immune system — resulting in chronic inflammation in the macula, which is a contributing factor of GA. Deregulation of the complement system has also been a suggested factor in the development and progression of GA and age-related macular degeneration (AMD). For more information on this promising new therapy from Apellis, visit www.apellis.com.

16 years since Malaysia hosted this important meeting and I’m confident that we’ll offer a wonderful venue for this occasion.” APAO Congress President Dr. Ningli Wang shared that more than 6,000 delegates from all over the world are expected to attend the meeting in Kuala Lumpur. Organizers are promising a top-notch scientific program, with global experts sharing their expertise and knowledge, as well as recent trial data and results. The event is scheduled to occur on-site (which is quite a treat after a year of virtual conferences!) from August 2-5, 2021. For more information, please visit https://2021.apaophth.org.

More Insight and More Freedom with Leica As a leader in surgical microscope technology, Leica helps surgeons see better — like with the next generation EnFocus intraoperative OCT, built into the Proveo 8 microscope. According to the company, these microscopes enhance vision, which allows the surgeon to focus and perform with precision. Further, this new innovation provides surgeons with more insight into hidden subsurface details; gives immediate confirmation on how tissue reacts to surgical maneuvers; and it offers maximum freedom in viewing and reviewing optimized OCT images … all of which help optimize patient outcomes. AAO attendees can register for a remote product demo by visiting the Leica booth or at www.leica-microsystems.com.

Imaging Solutions from Heidelberg Engineering Imaging solutions favorite Heidelberg Engineering is showcasing its latest innovations at AAO 2021. Visit the company’s virtual booth to learn more about Spectralis, an expandable diagnostic imaging platform that combines scanning laser fundus imaging with high-resolution OCT, or the HRT3 RCM, a compact ophthalmic device that uses confocal scanning laser microscopy to provide high-resolution images of the cornea and external ocular structures. Visitors can also learn more about the Heidelberg Eye Explorer (HEYEX 2) software which provides fast and simple access to diagnostic images, reports and maps from any Heidelberg Engineering device. For more information, visit https:// www.heidelbergengineering.com/int/

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CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

Rising to the Surface

Catch Alcon’s New Products by Brooke Herron

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rior to the kickoff of the annual meeting of the American Academy of Ophthalmology (AAO 2020 Virtual), Alcon held a media event to showcase the company’s newest innovations in intraocular lenses (IOLS) and digital health solutions. As a global leader in eye care, Alcon presented new data and key findings on its novel IOLs, as well as details on its new cloud-based surgical planning application, and other new offerings. Below, we touch on some of those highlights.

IOL duck dive During the webinar, Alcon released new information about soon-to-bereleased IOLs. This includes its first non-diffractive extended depth of focus (EDoF) AcrySof® IQ Vivity® IOL and the AcrySof® IQ PanOptix® Trifocal IOL.

Vivity IOL A number of speakers presented results on Vivity, including Dr. John Berdahl who discussed results from Clinical Outcomes of a New Non-Diffractive Presbyopia-Correcting Intraocular Lens. This study compared UCVA following bilateral implantation of Vivity versus an aspheric monofocal IOL. Results showed that 94%, 92% and 57% of Vivity patients reported good vision without spectacles at distance, intermediate and near; versus 90%, 63% and 25% with the monofocal IOL. This led Dr. Berdahl and colleagues to conclude that Vivity “improves intermediate and near vision quality while maintaining good distance vision and a low rate of visual disturbances.”

PanOptix Trifocal IOL Various data was also presented in support of Alcon’s PanOptix Trifocal IOL, including a poster titled Objective and

Subjective Assessment of Vision Quality of a New Trifocal IOL by Dr. Jeffrey Horn. In this study, Dr. Horn set out to evaluate binocular contrast sensitivity (CS) using CSV-1000 under photopic and mesopic conditions with and without glare with PanOptix Trifocal IOL, versus bilateral implantation of AcrySof Monofocal IOL. They found that the mean CS values for the trifocal group were within the normal range, with no clinically relevant differences observed between groups. According to the poster, “starbursts and halos were perceived in the trifocal group (57% and 65%), with a majority of subjects reporting these symptoms as “not bothered at all” to “bothered somewhat” (88% and 89%, respectively). Less than 5% of subjects with the trifocal IOL reported starbursts and halos as “bothered very much” at month 6.” Overall, the trifocal group edged out the monofocal group, with 99.2% of patients saying they would have trifocal IOL implanted again, versus 87.4% for the monofocal IOL.

Surfing the sweet digital suite The new SMARTCataract Planner and the ARGOS® Biometer with Image Guidance aim to offer innovative planning solutions for cataract surgeons.

SMARTCataract Planner Alcon also previewed its SMART Cataract Planner, which is a comprehensive, securely designed, cloud-based surgical planning app for Alcon IOLs. According to the company, this system is the first planner app offering the SMART Suite by Alcon, a digital health platform designed to streamline, simplify and improve cataract surgery for surgeons and patients.

ARGOS Biometer with Image Guidance Launched earlier this year, the ARGOS Biometer with Image Guidance is another tool in Alcon’s cataract planning suite, which has the unique advantage of measuring segmented axial lengths. Dr. H. John Shammas presented a paper showing the benefits the ARGOS called Differences Between Axial Length Measurements Using a Specific Refractive Index for Each Segment of the Eye vs. a Single Group Refractive Index for the Entire Eye: Effect on Intraocular Lens Power Calculation and Expected Clinical Outcomes. This paper found that there were differences between multiple axial lengths versus single measurements, which could affect precision in IOL measurements.

Bottom turn to the back (of the eye) Next, Alcon previewed a new product for vitreoretinal surgeons: the FINESSE REFLEX™ handle, which is designed to help surgeons move with ease and will be widely available to U.S. surgeons in 2021. For a demo, visit the retina section at Alcon’s AAO 2020 booth.

Looking down the line for LASIK outcomes Further, Alcon’s WaveLight® CONTOURA® VISION and Wavelight® Topolyzer® VARIO were also discussed. CONTOURA VISION uses personalized, topography-guided LASIK technology to achieve improved visual acuity in patients with myopia or myopic astigmatism. One study compared results from topographyguided LASIK treatments of myopia or myopic astigmatism versus correction based on manifest refraction. The authors found that topography-guided planning resulted in improved visual acuity and less residual cylinder, versus correction based on manifest refraction. Another study using the Wavelight Topolyzer VARIO imaging system showed that iris registration reduced overall variability in clinical outcomes for WaveLight Wave-Front Optimized LASIK treatments. Overall, the webinar was both informative and exciting — as these new products will help improve outcomes for patients and physicians.

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13 Nov 2020 | Issue #1

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CAKE & PIE POST (AAO 2020 Virtual Edition) - Issue 1  

CAKE and PIE magazines' Daily Congress News on the Anterior and Posterior Segments, AAO 2020 Virtual Edition.

CAKE & PIE POST (AAO 2020 Virtual Edition) - Issue 1  

CAKE and PIE magazines' Daily Congress News on the Anterior and Posterior Segments, AAO 2020 Virtual Edition.

Profile for mediamice