CAKE & PIE Post (53rd RANZCO 2022 Edition) - Issue 2

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30 | 10 | 22

HIGHLIGHTS deep-dived into 04 Experts their choice of IOLs – why TECNIS? inequity in eye 06 Levelling care ... find out more!

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fter a 3-year hiatus from meeting up physically, the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) 53rd Annual Scientific Congress opened on 29 October 2022 with a thoughtprovoking lecture by Dr. Ben Hamer, who spoke on the topics of futures thinking, technological innovations and disruptors that affect how we would work in the future.

Futures thinking While The Jetsons, a futuristic American animated sitcom produced by William Hanna and Joseph Barbara, had wooed the hearts of many in the 1960s, some of the predictions in the animation had actually come true today,

such as the video phone, robot vacuum, jet pack, printed food and smart watches, noted Australian futurist Dr. Ben Hamer.

“Futures thinking is intentionally talking about multiple futures, because we don’t know what the future looks like, but we can take the trends that we see today and think about what multiple alternative futures can look like,” said Dr. Hamer.

“By doing what we call back casting, which is to work backwards to what we are today, we can pull together a plan, or at least make decisions with the knowledge of what the future could be,” he explained.

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30 October 2022 | Issue #2

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“When we look at the innovations in the world today, they kind of show us that the future isn’t as far away as we might think. For example, in the deserts of North Africa and the forests of central Mexico, people are using scanners to uncover ancient lost cities,” he said, giving a few more examples as below.

For instance in China, there is equal presentation of boys and girls in high schools, and Chinese females in universities make up more than half of the students, up from a quarter in the 1970s.

In Delhi, India, facial recognition glasses are deployed and missing faces of children are uploaded, leading to success in tracking down 3,000 of the missing kids in just 4 days.

Melbourne has the largest 3D printer in the world and it is capable of making submarines and rockets.

In Israel, human fat cells are used to regenerate new human bones that are seven times stronger than our biological ones.

Then, there is instant translation.

“Waverly Labs has deployed the first instant in-ear translation device.

Language barriers are one of the biggest challenges of progress but that will disappear in the lifetime of everyone in this room,” he said.

As for medical technology, there are now devices that can read brain scans and diagnose autism at six months of age where human clinicians can’t diagnose until a minimum of two years old, as well as detect Alzheimer’s disease up to nine years earlier. With the help of Artificial Intelligence (AI), we are now more effective at spotting hard to detect breast cancer and reducing the rate of false positives by 25%.

“All these innovations show that there’s a lot of hope when it comes to human progress. There’s a lot of optimism and opportunities in the future when we think about what is already happening today,” said Dr. Hamer.

Disruptors to life and the way we work Next, Dr. Hamer delved into the 6 major disruptors in the world today, which include demographics changes; lifestyle; technology shifts; climate, energy and resources; trusts and transparency; and work.

“The global population is expected to peak at around 2064. After that the population starts to decline because of declining fertility rates. In 1950, globally, the average family had 4.6 children, now it is around 2.4 and going forward it will be down to 1.7,” noted Dr. Hamer.

“In 2030, we will have 1 billion more people in the world. But in Australia, the Australian Centre for Population already forecasted that we are going to have 1.1 billion fewer people than previously anticipated, probably due to the impact of border closure and slower migration, so our population growth won’t be as aggressive as in other countries,” he added.

He noted that in Australia, lifestyle is deeply tied to people’s values and the decisions they make. For example, in the last couple of hundred years, many people lived in the regional areas, but they gradually moved towards the coastal areas, driven by lifestyle.

In terms of technology shift, he spoke about the fact that today we have the ability to print submarines, rockets, food; as well as human organs which is currently under development.

He stressed that even though there’s a lot of great opportunities that come with technology advancement, it is the ethics and how we ensure trust and security with the use of technology that is paramount.

As for disruptors that shape our work and employee expectations, they include the automation of jobs, distrust in institutions, changing demographics of the

workforce, low wage growth and The Great Resignation.

He noted that automation is expected to increase in the next couple of years. “Five percent of jobs today may not exist by 2030 due to automation, however, more jobs will be created due to technology,” he said.

As for workforce demographics, currently there are five generations coexisting in the workforce and by 2025, millennials will not only be the dominant demographic, but the dominant proportion of managers in the workforce as well.

“Today, people are moving from job to job more frequently than they did in the past. We also have more vacancies than job seekers. This means that it is an employee’s market and employees are dictating a lot in terms of shift of expectations in the world of work,” Dr. Hamer explained.

So, what does work look like in 2030?

According to Dr. Hamer, the world of work in a decade will be very different than today.

The first scenario is the rise of neighborhood businesses. Central business districts (CBDs) will be reimagined, corporates will downsize central tenancy, there will be more people working from home, and there will be a rise of commercial office space in the suburbs, stimulating outer-metropolitan economies.

Second is the evolution of autonomous vehicle where self-driving mobile meeting rooms are used by companies to move their people between cities and states, minimizing disruption to collaborative work.

And thirdly, we shall see a prevalence of pet daycare in office buildings as a mental health and well-being initiative aligned with incentivizing workers to come into the office.

With the knowledge of these disruptors and trends, hopefully we can be more prepared in dealing with the inevitable changes in work and life as the waves of time push us into the future.

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30 October 2022 | Issue #2

Putting TECNIS to the Test

by Matt Herman

Two of the most popular IOLs in the modern cataract space get put through the meat grinder of scientific rigor at RANZCO 2022.

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f there’s one thing you can count on at a major regional ophthalmic conference like the 53rd Annual Scientific Congress of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO), it is celebrating the intersection of science and innovation. And at RANZCO 2022 in sun-drenched Brisbane, Australia, this is exactly what it’s all about.

It was standing room only for an eager crowd of headphone-clad doctors attending two post-lunch talks on Johnson & Johnson Vision’s popular TECNIS IOLs, Eyhance and Symfony at the EduHub on RANZCO Day 1 in the

Brisbane Convention & Exhibition Centre.

Hard science and raw data took center stage as these two lenses ran the gauntlet of two of Australia’s most notable names in cataract and refractive surgery.

The true cost of an EDoF intraocular lens lunch Every frequent ophthalmic congress attendee is beaten over the head with the aphorism of there being no free lunch in optics. It is, however, seldom that doctors go through the actual motions of explaining WHAT lunch costs. And this is precisely what Dr. Andrea Ang sought to do in her deep dive on the TECNIS Symfony extended-depth-of-focus (EDoF) IOL, entitled The Role of EDOF in My Daily Practice.

She began with a quotation from Swiss psychoanalyst Carl Jung: “A shoe that fits

one pinches another; there is no recipe for living that suits us all.” For Dr. Ang, the better a shoe fits in terms of range of vision, the more painful the pinch patients feel with quality of vision.

Dr. Ang began by referencing a 6-month binocular Symfony defocus curve. “At the 20/25 mark and above there’s a huge landing platform so that patients at the 1.5 defocus – which is about 60-70 centimeters – can achieve 20/25, and sometimes even better vision than that,” she said.

She then pointed to 2.5 defocus, where she found patients can achieve 20/40 vision. “It has a very large landing platform. It’s a very forgiving lens to use,” she said before pointing to excellent contrast sensitivity results via built-in chromatic and spherical aberration correction.

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

But eventually lunch has to be paid for, and this comes in the form of increased visual disturbances. It’s all worth it for Dr. Ang because of what she feels this buys her. “What I really like is that you get really good uncorrected distance to intermediate. And the near vision is not bad – that really surprised me – 6/7.5 on average,” she said during a data review of about 700 Symfony implantations. She also found in her audit that 50% of patients achieved spectacle independence, and 50% were weak readers in dim light or with very small print – remarkable results for an EDoF lens.

In the end, Dr. Ang acknowledged that there are many other lenses out there that will help patients with specific needs.

But the point she made is that the price of lunch for Symfony is tolerable given its wide-ranging benefits. In a world where intermediate vision reigns supreme, the Symfony allows her to provide patients with predictable results that enable her to underpromise and overdeliver on a consistent basis. And any refractive and cataract surgeon knows that this is a

tried-and-true recipe for success.

The power of simplicity The ever humorous Dr. Peter Sumich was up next with his talk TECNIS Eyhance & Eyhance Toric: A Surgeon’s Perspective.

And one thing was abundantly clear – he doesn’t like nonsense from patients, and the Eyhance is his ticket to no-frills results.

“Talking about the Eyhance is easy because I use it as my main lens. It’s about as easy as talking about your favorite golf club,” he began. “I don’t do many industry talks, but this was an easy one because it’s something I completely believe in,” he explained.

It did not take long for him to explain why with his uniquely cantankerous charisma.

“I want a lens that saves me chair time – I don’t want to chat and talk too much to patients with reams of questions,” he announced to peals of laughter.

Dr. Sumich then went through a list of his

expectations for a workhorse monofocal IOL to cut patient chatter. He wants a lens that delivers more than is expected, doesn’t degrade, has a nearly zero chance of dysphotopsias, and makes extending range of vision breezy with monovision. And it is only the Eyhance that checks those boxes.

For dysphotopsias, you won’t catch Dr. Sumich touching multifocal lenses.

“You can’t have something that focuses perfectly that also gives you multifocality.

Photons can’t be in two places at the same time. We need a sweet spot – something which is accurate and focused enough to not lose acuity, but also just a little bit of presbyopia management,” he explained.

And this is why he loves the Eyhance. “It’s effectively an optical pinhole. The depth of focus is brought to you by wavefront shaping of the image. It means you aren’t gonna get that perfect absolute precise focal point, but you’re not going to be far off it.”

He then went to the defocus curve.

“Effectively, the zero point is plano and as you get closer the acuity drops off. As you can see with the Eyhance, you will retain better near vision,” he said. “What that translates to is people not needing glasses as often as they would without this lens.” And that’s exactly what he’s looking for – no nonsense with visual quality with overperformance at ranges beyond run-of-the-mill monofocals.

Even better results can be obtained with some tweaking, and this is also a huge advantage of using a reliable, solid lens like the Eyhance. Targeting more negative or employing mono/minivision can really take refractive results to the next level. “With monovision you get a hard jump between the near and the far. And because [the Eyhance] has that soft dropoff, you can blend the two eyes better,” Dr. Sumich concluded.

In the end, Dr. Sumich compared the Eyhance to another lens that might give better near vision, but it was a familiar refrain. The more you try and squeeze out of the lens, and especially at the near range, the more visual quality suffers and dysphotopsias crop up. “If you don’t want to have to think too hard about [visual quality], I think that’s where [the Eyhance] is perfect. It has that sweet spot.”

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30 October 2022 | Issue #2

Leveling the Playing Field In Eye Care

by Matt Herman

Professor Clare Gilbert took on inequity in global eye care at the 2022 Fred Hollows Lecture at the 53rd RANZCO in Brisbane, Australia.

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Royal Australia and New Zealand College of Ophthalmologists (RANZCO 2022) was focused on a topic which drove this larger-than-life personality to the far corners of the Earth – inequity in eye care.

More than mere semantics

red Hollows is perhaps THE titan of ophthalmology in Australia and New Zealand. The notoriously cantankerous Kiwi with a massive heart worked tirelessly throughout his life to restore sight to some of the most remote and underserved areas of the world before his passing in 1993.

Lecture awardee Professor Clare Gilbert of the International Centre for Eye Health (London) delivered her talk, entitled “Inequity in eye health in low- and middle- income countries” to a packedto-the-rafters Great Hall 2 at the Brisbane Convention and Exhibition Centre in sunny Queensland, Australia.

And so it was more than fitting that the eponymous Fred Hollows Lecture at the 53rd Annual Scientific Congress of the

The beginning of the lecture began with a distinction between the terms inequality and inequity, the word that Fred Hollows

himself preferred. Inequality, said Dr. Gilbert, is about differences in health status, access to care, and outcomes.

Inequity is about differences in health that are unnecessary, avoidable, unjust, and unfair. It is the latter term that we should use to frame our efforts in the eye care space, and she went on to present data from around the world showing just how inequity in eye care is rearing its ugly head.

The many-headed eye health hydra The majority of Dr. Gilbert’s data focused on cataract and uncorrected refractive error from Nigeria, Pakistan and Sri Lanka. More than seventy seven percent (77.3%) of moderate to severe visual impairment and blindness are due to just these two conditions. A tragedy made all the more outrageous due to its preventability with either null or basic diagnostic equipment.

Dr. Gilbert then went on to highlight what she termed effective cataract surgical coverage (eCSC). This is a proportion of people with operable cataracts who have undergone surgery. One of the key points

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

of the lecture was her argument for its use around the globe as a proxy for how good a country is at preventing blindness.

A flurry of data ensued, with a potpourri of pie charts, line graphs, and tables showing putative causal relationships between a variety of parameters. She showed positive correlations between such things as low household income, sex (females are notably less likely to receive care and thus more likely to become blind), literacy (71% of all cataract blindness was in non-literate participants), marital status, and ophthalmologists per capita. “Often [preventable blindness] is because people don’t know what’s wrong with their eyes, don’t know where to go, or don’t have someone to accompany them,” she concluded.

but daunting mechanisms of action to bring quality eye care to the masses.

Political and social change to address the aforementioned underlying causes of inequity are critical, but difficult to achieve.

But things are being done. She referenced the 2018 World Report on Vision, 2021 Lancet Commission on Global Eye Health (we interviewed James Chen, one of the chief architects of this commission and the resulting UN resolution in a previous issue of COOKIE Magazine), and the WHO’s Universal Health Coverage as conduits for the type of massive change needed to address inequity.

The ABCs of could and would

But international resolutions are empty without concerted concrete action at the country level. “There is a lot of advocacy and leadership needed at the national level for adoption of the UN Resolution,” she concluded.

According to Dr. Gilbert, there are clear

There are many avenues for this to take

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place, but one of the keys is adoption of metrics like eCSC. “I think if this indicator is adopted, then all countries will be obliged to collect this data and report on it. And we all know that what gets measured is what gets done”.

What must be done Dr. Gilbert concluded the lecture with a series of recommendations moving forward. Among them were advocacy and leadership, monitoring access to services, improving eye care service quality and a more robust body of research.

Her final thoughts on the task ahead of us were summed up on her final slide with a Maori proverb from Fred Hollows’ native New Zealand. “Pursue that which is precious, and do not be deterred by anything less than a lofty mountain.” And if Dr. Gilbert has anything to say about it, even lofty mountains will tremble with a concerted global effort to prevent blindness.

RANZCO Exhibit #45 Images courtesy of Karl Brasse, MD, MRCOphth

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