CAKE & PIE POST (AIOC 2020 Gurugram, India) - DAY 3

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Biosimilars or novel molecules? Experts weigh in on their choice of anti-VEGFs... read more.


Expert sessions at ZEISS booth #102, see what you missed...

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IOC 2020 was privileged to have the honor of two distinguished doctors selected this year to present the President’s Guest Lectures: Prof. Chee Soon Phaik (Singapore) and Prof. Harminder Singh Dua (United Kingdom). Professor Chee Soon Phaik is a professor of ophthalmology at the National University of Singapore (NUS) as well as the Duke-NUS Medical School. She is also the senior consultant and head of the Cataract Subspecialty Department and Ocular Inflammation & Immunology Department at the Singapore National Eye Centre (SNEC). At the AIOC President’s Guest Lectures this year, Prof. Chee shared her expertise on CAPSULaser (EXCEL-LENS, California, USA), highlighting her discoveries which



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Prof. Chee Soon Phaik

Prof. Harminder Singh Dua

Oculus celebrates its 125th anniversary this year, and here, we celebrate originality with Oculus, “The Original.”



Traditional performer on Day 2 of AIOC 2020 with Media MICE writer, Joanna Lee

were published in the British Journal of Ophthalmology entitled Comparison of Anterior Capsulotomy Techniques: Continuous Curvilinear Capsulotomies, Femtosecond Laser Assisted Capsulotomy and Selective Laser Capsulotomy.1 The study compares the relative threshold forces to initiate an interior tear for capsulotomies formed by selective laser capsulotomy (SLC), CCC and femtosecond laser assisted capsulotomy (FLACS)

15 February 2020 | Issue #3

techniques. Through looking at its various applications, she said the main feature of the CAPSULaser is that its edge is elastic, strong and tear resistant. CAPSULaser is described as compact. While it is mounted under the microscope, it also adds to working distance. It is not inserted into the anterior chamber and performs stronger capsulotomy compared to the manual CCC. Its centration is not automated and it is more cost effective than FLACS but more costly than the Zepto (Mynosys Cellular Devices, California, USA). Prof. Chee concluded that SLC is significantly stronger than CCC, which is in turn significantly stronger than femtocapsulotomy. Scanning electron microscopy findings reflect the structural changes present in the eyes, thus, supporting the finds and clinically, she said, SLC may provide increased surgical safety by reducing the chances of anterior capsular tears during cataract surgery. The second lecturer was Professor Harminder Singh Dua, professor of ophthalmology and visual sciences at

University of Nottingham, United Kingdom. In 2013, Prof. Dua and other researchers at the University of Nottingham discovered a layer of the human cornea which lies between the corneal stroma and the Descemet’s membrane.2 This pre-Descemet layer discovered was subsequently named Dua’s layer which he said would make corneal transplant surgeries technically safer.3 His lecture titled Steering the Ship, from Studentship to Leadership gave the audience a closer look at the humble man and his driving philosophies which has led him towards stellar achievements. It is also a lecture which paid tribute to his lifelong mentors, peppered with relevant, insightful anecdotes while highlighting his fascinating scientific discoveries. Prof. Dua reiterated throughout the lecture through his examples that “the eye cannot see what the mind doesn’t know”, meaning that “only when one can look at something and see beyond what the mind knows can new discoveries be made.” He also made a call for doctors to be lifelong students and to


Welcome You All

To the largest Scientific feast in the world of Ophthalmology

Prof. S. Natarajan President

Prof. Namrata Sharma Hony. General Secretary

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

hold on to the powers of observation. It was these very observations that have led to his discovering of the unique role of limbal stem cells to the healing of corneal epithelial wounds.4 Subsequently, this observation turned discovery helped carve his niche in ocular surface reconstruction with limbal stem stells. Another highly interesting discovery was his observation of the underlying mechanism of electromagnetic fields in the “hurricane keratitis” phenomenon. It was less talk and all action as Prof. Chee then took the stage again to share what was essentially a master demonstration of Scleral Sutured IOL. She gave the audience a glimpse into her deft surgical skills creating suture snares for scleral fixation of intraocular lenses and capsular tension devices.5 She concluded that the Goretex 7/10 is

a strong, user-friendly suture for scleral fixation as it can be anchored directly through the capsule. She also mentioned the Canabrava technique using flanged polypropylene 6/0 which spares the conjunctiva. Prof. Dua then gave his second lecture with a look at the unidirectional scrolling of the endothelial keratoplasty (EK) procedure. It is crucial to get the right orientation due to its scrolling while operating on the eye, thus, an understanding of its physiology is important. As they sought to understand the physiological purpose behind the scrolling, the answer came differently than the assumptions taught in textbooks (again, the power of observation at work) as Prof. Dua and his team discovered that elastin is what determines the direction of the scrolling.

Mentorship steers young ophthalmologists in the right direction – was the takehome message from Prof. Dua’s lecture on Steering the Ship, from Studentship to Leadership.

OCULUS & KLB India premieres at AIOC! Be part of the ribbon-cutting ceremony Friday and Saturday at 2.30 pm and 4.30 pm at the KLB booth no. 107 KLB KLB Instruments Co. Pvt. Ltd

References: Daya S, Chee SP, Ti SE. Comparison of anterior capsulotomy techniques: continuous curvilinear capsulorhexis, femtosecond laser-assisted capsulotomy and selective laser capsulotomy. Br J Ophthalmol. 2019 [Epub ahead of print]



Dua HS, Faraj LA, Said DG, et al. Human corneal anatomy redefined: a novel pre-Descemet’s layer (Dua’s layer). Ophthalmology. 2013;120(9):1778-1785.


The Telegraph India. Available at: https://www.


Chee SP, Chan NS. Suture snare technique for scleral fixation of intraocular lenses and capsular tension devices. Br J Ophthalmol. 2018;102(10):1317-1319.


Dua HS, Azuara-Blanco A. Limbal stem cells of the corneal epithelium. Surv Ophthalmol. 2000;44(5):415-425.

Media MICE wishes outgoing AIOS President Prof. S. Natarajan congratulations on his excellent year in office.




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around AIOC 2020

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

Biosimilars VS. Novel Molecules

within 6 months, he deemed, seems to reveal the sustained benefits of Razumab. Offering a differing view, Dr. Ajay Dudani presented on why his preferred molecule for the management of nAMD is ranibizumab. He cited The Great Vitreoretinal numerous landmark studies Treatment of Choice Debate like the MARINA (Minimally Classic/Occult Trial of the Antiby Joanna Lee VEGF Antibody Ranibizumab in the Treatment of Neovascular hile the atmosphere was slightly AMD) and the EXCITE (Efficacy and safety more relaxed in the cozy small hall, of monthly versus quarterly ranibizumab the presentations were charged up by the treatment in neovascular age-related time limit and the myriad of questions and macular degeneration) studies which answers in between the presentations. showed about 6 letters of VA gained At the Vitreoretina Session yesterday, 23 while SUSTAIN (Study of Ranibizumab doctors presented a wide range of topics in Patients With Subfoveal Choroidal ranging from retinopathy prematurity (ROP) Neovascularization Secondary to Agein pediatric patients, posterior segment Related Macular Degeneration) also showed vascular complications after cataract similar results. While the HARBOR (A Study surgery, to questions of whether cataract of Ranibizumab Administered Monthly or surgery causes progression of age-related on an As-needed Basis in Patients With macular degeneration (AMD). Subfoveal Neovascular Age-related Macular Besides surgical complications, Degeneration) study showed individualized treatments were discussed and one ranibizumab dosing resulting in meaningful interesting line of differing discourse stood VA gains which were sustained over 24 out: “When it comes to drugs of choice, it months. Dr. Dudani argued that while can be a tough call in deciding between manufacturers of biosimilar drugs design experiences and intuition or based on them to have similar active properties to the numbers from studies.” ones previously licensed, the manufacturers In this line of topic, Dr. Jacob Chacko aim at designing just the structural analogs spoke on the safety and efficacy of Razumab to the novel molecule which may result in with minimum 6-month follow-up, minute differences (in chemical analogs) making a case for the use of this biosimilar that go unnoticed. Thus, he emphasized on drug produced readily in India, having the words: “similar, but not identical”. The experienced some limitations in the use of concern was that the small undetectable ranibizumab and bevazizumab. Reporting differences compared with the originator on a study of 210 patients treated with products may lead to unexpected Razumab with 52 patients receiving a 6-month follow up, he said AMD patients recorded an improvement in 13/15 cases and 2 out of 15 were stable. Diabetic macular edema (DME) patients also experienced an average visual gain of 6 letters while 17 out of 19 had 5 letters gain while in RVO patients, about 67% of patients (two-thirds) had 2 to 3 lines of visual gain. There were no adverse reactions reported. Dr. Chacko concluded that Razumab is safe, economical and efficacious and works as well as the novel molecule. He also found that it works across indications while its use also avoids logistical and medicolegal Dr. Ajay Dudani complications. Multiple injections reviewed


immunogenicity in patients. The friendly discourse moved back in favor of Razumab when Dr. Ashish Sharma took the podium to share why he prefers Razumab in neovascular age-related macular degeneration (nAMD). He pointed out the safety factor through a little seen fact that when Razumab was launched in 2019, the incidence rate was recorded at 0.7% after looking at the numbers published. In his observation, it took the manufacturer 7 years to bring down the incidence rate of ranibizumab to 0% while for Razumab the numbers went to 0% within 3 years. As for the potency of Razumab, he pointed out that studies showing the efficacy of ranibizumab were published with support by the manufacturing company, leading him and his colleagues to publish a paper.1 He also brought up the question of why real world visual gains are normally poorer compared to trial results besides pointing to the more affordable costs of using biosimilars. Finishing off his presentation, Dr. Sharma made a case for combating bias of a drug produced in India2 and in general, the bias against biosimilars for the benefit of all through a few published journal articles.3

References: 1 Sharma A, Hafeez Faridi M, Kumar N, et al. Immunogenicity and efficacy after switching from original Ranibizumab to a Ranibizumab biosimilar: realworld data. Eye (Lond). 2019 [Epub ahead of print] 2 Sharma A, Kumar N, Kuppermann BD, et al. Ophthalmic biosimilars: Lessons from India. Indian J Ophthalmol. 2019; 67(8): 1384–1385. 3Sharma A, Kumar N, Bandello F, et al. Need of education on biosimilars amongst ophthalmologists: combating the nocebo effect. Eye (Lond). 2019 [Epub ahead of print]

Dr. Ashish Sharma




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ZEISS Showcases Innovations at AIOC 2020


n the second day of AIOC 2020, delegates flocked at the ZEISS booth (#102) for a full day of Surgical, Diagnostic and Refractive Expert Sessions.

The Next Generation of Advanced Slit Lamp Microscopy Dr. Ram S. Mirlay, an eye surgeon from Bangalore, says that the SL-800 slit lamp is a gamechanger. “It’s a major innovation. It has an extra wide-angle optic that gives you a wide-angle fundus view. The optical definition is on a Meyer Scale of 8 – this means that eye surgeons can detect disease earlier,” he said. The SL-800 also allows for easier user operation, like the one-stop button and the automatic optic changer, which facilitates one-handed operation. “This is immensely useful for retina examination because the other hand is occupied holding the lens,” he explained. “With the high definition camera and LCD screen, we can demonstrate lesions clearly, which are difficult for the human eyes to appreciate.”

A New Dimension in Diagnosis and Management of Retinal Diseases Dr. Shamik Mokadam, a retina specialist from Nagpur, has been using ZEISS equipment since completing his fellowship in 2007. His first purchase was the CIRRUS 4000, and he currently uses the CIRRUS 5000. “The Forum software makes integration between different equipment seamless, which allows for better patient counseling,” said Dr. Mokadam. “Data from the [CIRRUS] 4000 can be transferred over, so I can use my old database and do comparisons between previous and present scans. Plus, the image acquisition and quality is far superior compared to the rest in the market.”

by Brooke Herron

ZEISS has also released the CIRRUS 6000, its next generation OCT.

Zero Energy Fragmentation with miLOOP For the past six months, Dr. Sheetal Brar, senior consultant, research and academic coordinator at Nethradhama Super Speciality Eye Hospital in Bangalore, has been using the miLOOP lens fragmentation device from ZEISS. In the past, she said that managing hard brown cataracts was very challenging: “Even though you are experienced, you can still have complications.” “The miLOOP is a boon for surgeons; it improves safety. It is capsule- and zonule-friendly and it ensures a complete division of the nucleus – this is the biggest advantage,” she continued. “This is the only instrument available right now that ensures 100% full-thickness division of the nucleus.”

for emmetropia in one eye and 0.5 myopia in the other,” he explained, adding that overall, less than 5% experienced initial difficulty getting used to trifocal vision, but that they improved with time.

Digital Imaging and Operating Tools Dr. Sartaj Grewal, a consultant at Grewal Eye Institute in Chandigarh, uses the ARTEVO 800. One advantage is the complete Cataract Suite, which simplifies his workflow from investigation to surgery: “There are fewer steps and less calculations, it saves me a lot of time and stress.” He continued that there are a lot of subtle factors that make the overall experience with ARTEVO different. “Once you get used to it, it’s hard to go back. It’s more comfortable, it has better visualization, better ergonomics, and it truly shines as a teaching tool. It’s unparalleled,” he concluded.

Attention Delegates If you missed the first day of ZEISS’s Expert Sessions, don’t worry. These informative sessions continue on Day 3 (February 15) at Booth #102.

Getting the Best Outcomes with IOLs Dr. A.G. Chinnappa from Prasad Netralaya Eye Hospital in Udupi, India, said that he uses most of the IOLs that ZEISS offers, including the AT LISA Tri893MP. “The confidence I have [in ZEISS products] is high,” said Dr. Chinnappa. “The amount of light loss compared to other IOLS is much Dr. Sartaj Grewal less – plus, and most importantly, it allows me to consistently provide good results for near vision.” He said that he uses ZEISS trifocal IOLs on about 50 to 60 patients annually, making a small vision modification: “I go

Dr. Sheetal Brar

Dr. Shamik Mokadam

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




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