CAKE Post (APACRS 2023 Edition) - Issue 3

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Matt Young CEO & Publisher

Hannah Nguyen COO & CFO

Gloria D. Gamat Chief Editor

Mapet Poso Editor

Maricel Salvador Graphic Designer Writers

Brooke Herron

Hazlin Hassan

Matt Herman

Tan Sher Lynn

Ruchi Ranga Customer Care International Business Development

Brandon Winkeler

Robert Anderson

Adam Angrisanio

We’ve Come A Long Way

APACRS 2023 ushers in new connections and fresh beginnings with colleagues old and new

Spirits were high and anticipation filled the halls of Suntec Singapore Convention & Exhibition Centre as the APACRS organizing chairman, Dr. Chan Wing Kwong (Singapore), delivered his welcome speech, promising an exciting, informative program this year.

“The committee has worked very hard to put up a program that is curated, focused, relevant, and up to date — delivered by some of the most eminent speakers from across the Asia-Pacific region and beyond,” he noted.

He also took the audience on a wonderful trip down memory lane with a video showcasing APACRS milestones and meetings in different countries over the years since its inception in 1987.



Probably not since APACRS 2019 have we been able to connect with friends so strongly at the APACRS meeting. Here, Media MICE CEO Matt Young connects with longtime friend Bernie Ursell, Head of Professional Education, Refractive & Surgical, Global at ZEISS.

cataract • anterior segment • kudos • enlightenment 3ISSUE CAKE MAGAZINE’S DAILY CONGRESS NEWS ON THE ANTERIOR SEGMENT 10 | 06 | 2023
Cont. on Page 3 >>
matter Next, guest of honor Dr. Vivian Balakrishnan,
Experts at APACRS 2023 give us the lowdown on the latest in presbyopia correction with IOLs When it comes to presbyopia treatment, the RayOne EMV promises to provide uncompromising range and comfort 06 04 HIGHLIGHTS
Media MICE Pte. Ltd. 6001 Beach Road, #09-09 Golden Mile Tower, Singapore 199589 Tel: +65 8186 7677 Email: Published by Please note that this is an independent publication of Media MICE Pte Ltd (“Media MICE”) in our role as independent media. Media MICE is in no way affiliated to or with any person, organization, or entity mentioned in this publication, nor is this publication published in any way intended to convey any such affiliation.
Day 2 of the 35th Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2023) annual meeting, one of the most important scientific meetings in the region, opened with renewed aspirations for better
enhanced eye care.
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Minister for Foreign Affairs, Singapore, gave a poignant speech that reminded the audience how great it is to be able to finally meet each other in person again after the pandemic, and the importance of the clustering of the critical mass of minds that made today’s scientific and technological revolution possible.

“There’s still no substitute for a handshake, looking at each other’s eyes, and taking up extra cues which go beyond simply what we say on videos. Our experience of COVID-19 taught us the importance of having the best minds — clinicians, scientists, researchers, engineers — all together in the same room, working on common problems and achieving things on a global scale,” he said.

Last but not least, APACRS president Prof. Yao Ke (China) delivered his opening address, who took the opportunity to thank the speakers, ophthalmic societies, organizing members, staff, sponsors, and exhibitors for their contributions in making this event a success.

“As the world emerged from the pandemic, we are excited to enter a new era, that is to reconnect and restart the face-to-face exchange of cutting-edge topics and techniques after the challenging times. APACRS has provided us an opportunity to learn, engage, bring home new knowledge and skills, and also to connect with colleagues and friends. We all share the common goal of wanting to deliver the very best eye care for our patients,” he remarked.

Well-deserved recognitions

After the speeches, awards were presented by Dr. Yao to the deserving recipients, including the APACRS Certified Educators (A.C.E) Award — a program motivating ophthalmic surgeons in the region to play a more active role in disseminating the latest advances and techniques to their colleagues; the APACRS Gold Medal Award — which acknowledges the significant contributions of ophthalmologists to the development

of cataract and refractive surgery in the region; and the APACRS Lim Lecture — which recognizes outstanding ophthalmologists for their extraordinary contributions to the development of cataract and refractive surgery.

This year, the APACRS Certified Educators Awards went to Dr. Mahipal Sachdev (India), Prof. Mohamad Rosman (Singapore), and Prof. Jodhbir Mehta (Singapore). Meanwhile, the APACRS Gold Medal Award was presented to Dr. Fam Han Bor (Singapore).

APACRS Lim Lecture — Developments in IOLs

As for the APACRS Lim Lecture Award, the highest award of the society, this year’s deserving recipient is one of the world’s leading intraocular lens (IOL) experts, Prof. Gerd U. Auffarth (Germany), who enlightened the audience with a talk entitled “Current and Future Development in Intraocular Implants with New Materials.”

Prof. Gerd began his talk by describing the evolution of monofocal IOLs, which according to him, have advanced tremendously. “All kinds of optical principles have also been developed in premium IOLs, such as diffractive optics, refractive optics with spherical aberration, and special optics with small aperture principle. It’s a jungle out there. There are so many types of lenses available nowadays,” he said.

He proceeded to explain presbyopiacorrecting IOLs under different categories: Enhanced monofocals, extended depth of focus (EDoF), extended range of vision (ERV), and trifocals.

“At the end of the day, all of these lenses give us, more or less, a larger ‘landing zone’ in order to achieve full vision and emmetropia in our patients,” Prof. Gerd noted.

A peek into the future of IOLs

Prof. Gerd also mentioned that with the current technology, binocular trifocality and reversible trifocality are achievable.

Looking into the future, he foresaw better IOL materials, such as those with higher biomaterial stability and purity, as well as novel polymers with enhanced optical and mechanical properties.

In terms of monofocal IOLs, he expected fine-tuning when it comes to design, material, and optical quality; extending optical features like depth of focus and peripheral vision; and adjustable IOL technology or modular approaches.

“For EDoF lenses, there will be more non-diffractive technology. Dysphotopsia profile will be similar to monofocal IOLs, but there are limitations in terms of reading ability. Trifocal/diffractive IOLs have reached a very high level but there’s still space for improvement, especially in terms of light balance, depth of focus, and dysphotopsia. An option will be hybrid approaches with non-diffractive optical components,” he continued.

To conclude his talk, Prof. Gerd gave us a peek into accommodative IOLs like the liquid-filled implants with shapechanging modular technology, which is interesting but still far away, as well as optoelectronic/mechatronic devices, which are still in the concept phase.

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APACRS 2023 awardees with APACRS President Prof. Yao Ke and other dignitaries

The Power of Range

and a design that provides a smoother transition between distance and near vision.

A truly non-diffractive IOL

The RayOne EMV is an FDA-approved intraocular lens for presbyopia treatment, which provides an increased range of high-quality distance and intermediate vision and functional near vision with less dependency on glasses.

When it comes to presbyopia treatment, the RayOne EMV provides uncompromising range and quality of vision

At the 35th Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2023) annual meeting in Singapore, top surgeons from around the world presented on trending technologies in treating presbyopia in a Day Two session entitled “TRENDING TECHNOLOGIES – Highway to the Future.”

During the session, Prof. Graham Barrett (Australia) and Dr. Sri Ganesh (India) discussed monovision and capsulotomy-fixated IOLs, respectively. Prof. Barrett also shared the experiences that led to him collaborating with Rayner on developing the RayOne EMV, an FDA-approved, non-diffractive enhanced monovision IOL.

Treating presbyopia for cataract patients has become a key focus in ophthalmology in the last few years, with more choices now available beyond multifocal lenses.

The past decade-plus has seen a rise in the popularity of extended depth-offocus (EDOF) IOLs, which claim to give patients good distance, intermediate and near vision.

One of the newest EDOF offerings is the RayOne EMV lens, an extended range of vision IOL that is nondiffractive and utilizes positive spherical aberration to extend range of vision whilst avoiding issues that arise with diffractive lenses.

What makes the RayOne EMV lens different from other EDoF lenses is its optimization for enhanced monovision

The EMV concept was developed by Prof. Graham Barrett and brought to market by Rayner, who produced the world’s first IOL in 1949. The RayOne EMV is the first and only lens of its kind, revolutionizing cataract results for patients worldwide.

In his talk at APACRS 2023, Prof. Graham Barrett explained that multifocal, trifocal and diffractive EDoFs often result in a compromise in optical quality including dysphotopsia, halos and glare. He showed how there are many choices for presbyopia and advised surgeons to consider what optical principle they think is likely to provide patients with a solution that allows for unaided near vision, thus giving them higher levels of postoperative satisfaction.

Compared to many other IOLs, the RayOne EMV lens offers several

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advantages. It provides excellent vision in low light conditions, reduces glare and halos and maintains excellent contrast sensitivity.

The RayOne EMV is a truly nondiffractive IOL that does not use light splitting technology like many IOLs that increase depth of focus. This results in desirably low levels of dysphotopsias similar to standard monofocal lenses.

The art of designing optics

During the session at APACRS 2023, Prof. Barrett said that he designed the EMV to be used with what he terms an enhanced monovision approach.

He and other surgeons have used a monovision approach for many years with regular monofocal IOLs. But now with the RayOne EMV, this monovision effect has been enhanced and true blended vision achieved.

A keen astronomer in his spare time, Prof. Barrett explained to the audience that using a telescope requires perfect quality and related this to mechanisms in the human eye.

“You can tell the quality of a telescope by moving the focus in and out while you focus on a single star. This, of course, reminds me of the adjustable focus of the human eye. But, unfortunately, when you implant an IOL, you no longer have this adjustable focus mechanism,” Prof. Barrett shared.

As an alternative to either a monofocal approach or splitting light into different foci, he presented the enhanced monovision IOL concept — a trending optical strategy in the treatment of presbyopia. In contrast to multifocal IOLs, enhanced monovision lenses create a single elongated focal point by adding a small amount of positive spherical aberration, rather than several foci, to enhance depth of focus.

“It’s really a balance between perfect resolution on the one hand, and adequate depth of focus [on the other]. Finding that elusive balance is the art of designing optics based on this principle,” he noted.

How does the RayOne EMV work?

The RayOne EMV is the only patented aspheric IOL that induces controlled positive spherical aberration. Compared to a lens with zero spherical aberration, the carefully-controlled positive spherical aberration induced by RayOne EMV spreads light along the visual axis, elongating the focal range from far to intermediate with up to 1.5 D of depth of focus with an emmetropic target. The great thing with the EMV lens is that even without the use of monovision, patients achieve excellent distance, intermediate and some near vision.

Most patients implanted bilaterally with this non-diffractive enhanced monofocal intraocular lens targeting micro-monovision ended up with good distance and intermediate vision, and many achieved spectacle independence.

The lens is thus designed to provide a smoother, blended transition between the eyes when compared to monovision with standard monofocals or other EDoFs, maintaining binocular stereoacuity and reducing asthenopia.

Achieving high-quality, spectacle-free distance vision

Dr. Sri Ganesh, chairman and medical director at the Nethradhama Super Specialty Eye Hospital, India, also spoke at the session on the new, innovative capsulotomy fixated IOL technology in the RayOne EMV.

Commenting on Prof Barrett’s talk, he said that as some patients face issues

such as dysphotopsias and night vision concerns with other IOLs, he recommends using the RayOne EMV.

“I started out using diffractive EDoFs… but then you have dysphotopsia and other issues. You always have some kind of compromise. What I find is that, with [the RayOne EMV], patients get the best spectacle independence,” he shared during the question and answer session.

As chair of the symposium, Prof. Barrett also commented that quality of vision is the most important thing and that an extended depth of focus can be achieved without diffraction by using positive spherical aberration.

While each patient’s needs are unique and need to be assessed before selecting an IOL, overall, Both Prof. Barrett and Dr. Ganesh concluded that the RayOne EMV is an excellent choice for patients undergoing cataract surgery, providing clear, high quality visual outcomes and an extended range of vision.

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All Eyes on the IOL

Experts at APACRS 2023 give us the lowdown on the latest in presbyopia correction with IOLs

changes and the fact that hyperopes get more and more hyperopic over time.

Nevertheless, he doesn’t recommend performing LASIK for hyperopia even though it’s safe and easy — because LASIK has a limited correction range (<+3D), cannot treat presbyopia (except for aspheric ablation profiles), causes dry eyes after surgery, and doesn’t change the need for cataract surgery later in life.

At his eye clinic, EuroEyes, performing refractive lens exchange (RLE) with trifocal IOLs is the standard of care for hyperopic patients. The clinic recorded 95% patient satisfaction after primary refractive RLE surgery.

“I believe that performing RLE with trifocal IOLs is the best option in hyperopes above 30 years. It fully corrects all refractive errors including presbyopia, is permanent, and results in a stable solution. It does not cause retinal complications or dry eyes. It is a well-established and standardized surgery, and it can prevent cataract surgery later in life,” he commented.

Small aperture IOL

Ophthalmologists from Europe and the Asia-Pacific offered their views on selecting the suitable IOL and solution for presbyopia and hyperopia correction during a session entitled “The New Black in Presbyopia Correction” on Day 2 of the 35th Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2023) annual meeting.

Dr. Florian Kretz (Germany) explained the different IOL technologies available today, saying that for the overall vision, a combination of extended depth of vision (EDoF) and trifocal lenses (mix and match) is always a good choice.

For less dysphotopsia, monofocal plus with EDof IOLs (blended) will lead to better full-range vision. If one prefers distance-focused vision, EDoF IOL can provide emmetropic vision with hardly any dysphotopsia and spectacle independence to around 55 cm. Meanwhile, multifocal intraocular lens (MIOL) provides good visual acuity for distance and near vision, and true binocular near vision.

Hence, he stressed that the key questions to ask when choosing an IOL are whether the patient is suitable for diffractive optics (able to accept halos), how much defocus the cornea already creates, and which other optical principles suit the patient’s eye best.

“We have lots of technology available now so we can start to match the technology to the individual patient and not have one solution that should be fitting everyone,” he noted.

LASIK vs. refractive lens exchange for hyperopia

According to Dr. Michael Knorz (Germany), the lens in our eyes changes with age, leading to refractive

Meanwhile, Dr. Robert Ang (Philippines) offered tips and pearls for small aperture IOL surgery.

Drawing from his experience of using the IC-8 lens, Dr. Ang noted that patients with complex aberrated cornea may be a good population to start with for surgeons with less experience in small aperture IOL surgery.

“When you gain more experience, you will build confidence in using the IC-8 as a premium mono vision/low toric option in normal corneas,” he shared.

He noted that pre-op planning and managing patient expectations are important. “Don’t overpromise. With its extended range of focus, far vision is likely assured with strong potential for intermediate vision, while near performance is similar to EDoF and not trifocal lenses. It is also important to counsel the patient about the need for illumination and the possibility of glare and halos,” he concluded.

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Melding Movies and Medicine

Winners in each category

Grand Prize: Spiral CTR Injector, Takahiro Shimowake (Japan)

Cataract/Implant Surgery

Winner: The Optimal IOP for the Stable Anterior Chamber in Cataract Surgery, Hisaharu Suzuki (Japan)

Runner Up: A New Miyake-Apple View System Using a Nasal Endoscope, Takeshi Sugiura (Japan)

Cataract Complications/ Challenging Cases

Winner: Innovative Extraction Technique for Dislocated Intraocular Lens, Santaro Noguchi (Japan)

Runner Up: The Polar Bug, Tushya Om Parkash (India)

Refractive/Corneal Surgery

As expected, this year’s APACRS Film Festival delivers and does not disappoint

Visuals can have a stronger impact than the written word. Most of the time, films can help deliver a message faster and more effectively. This was evident during the Film Festival Symposium and Awards Ceremony at the 35th Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2023) annual meeting held yesterday, where this year’s best films were honored and celebrated.

This year saw stiff competition featuring over 70 videos by aspiring and seasoned filmmakers from 15 countries submitted for consideration in the APACRS Film Festival competition sponsored by Alcon.

The Cataract Implant Surgery Category had the highest number of submissions — 23 in total. A recent global survey run by Alcon called Eye On Cataract revealed that patients ranked vision as the second-most important aspect of aging, second only to memory, said Chintan Desai, Alcon vice-president (surgical) for the AsiaPacific.

“At Alcon, we understand the importance of vision in patients’ lives and the need for innovation and

the difference it can make,” he said, adding that experts such as surgeons at congresses like the APACRS help in bringing together ideas and innovations.

Creative display of innovations in ophthalmology

During the ceremony, the audience was treated to presentations of the must-watch winning entries, which were entertaining and educational — creatively displaying innovations and breakthroughs in ophthalmic surgery.

The panel of judges who vetted the entrants were attired in colorful batik shirts at the awards ceremony, a nod to host-country Singapore’s culture and heritage.

Winner: Tissue Addition for Hyperopia — The Whole Story, Sheetal Brar (India)

Runner Up: Fog Away SLET, Kyong Woo Kim (South Korea)

General Interest

Winner: Future Forward — Artificial Intelligence Assisted Eye Care

Runner Up: A Modified Sewing Machine Technique for Iridodialysis Repair, Elizabeth Aileen Giller (Philippines)

Dr. Sheetal Brar, cataract and refractive surgeon at Nethradhama Superspeciality Eye Hospital, India, and winner of the Refractive/Corneal Surgery category, revealed that she had already won nine consecutive APACRS Film Awards, to which a judge quipped that the organization could appoint her as a judge in the future so that other candidates would have a chance at winning.

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