The comprehensive ophthalmology program of this year’s Hawaiian Eye meeting, which was recently held at the Hilton Waikoloa Village, featured an expanded 7 day agenda covering a wide range of topics: oculoplastics, practice management, cataract surgery, glaucoma, retina, ocular surface disease, and refractive surgery. The presentations reviewed important subjects general ophthalmologists deal with on a daily basis, summarized findings from recent clinical trials, and updated the status of new technologies and procedures. Below is a summary of the highlights from the sessions:
Oculoplastics
Dr. Wendy Lee, the course director for the oculofacial plastic surgery symposium, organized an educational morning that included discussions about the principles of both functional eyelid surgery and aesthetic oculoplastics. In the former, the management of eyelid lacerations, malpositions, and common lesions were presented. In the latter, Dr. Lee was joined by Drs. Joely Kaufman, Steve Yoelin, and Femida Kherani. They concentrated on the use of botulinum toxins and dermal fillers, and a live injection workshop concluded the session.
Practice management
This session included talks by meeting veterans John Pinto, Alan Reider, and Kevin Corcoran. The presentations reviewed financial, legal, and ethical issues in today’s changing ophthalmic environment.
Cataract surgery
Advances in techniques and technology to improve patient outcomes were the focus of this session that was moderated by Drs. David Chang and Roger Steinert. The speakers discussed a broad spectrum of topics including premium IOLs, novel accommodating IOL designs, intraoperative wavefront aberrometry (Wavetec ORA), femtosecond laser assisted cataract surgery (Alcon LenSx, OptiMedica Catalys, LensAR laser, B+L Victus), IOL power calculations (especially in patients who have had previous corneal refractive surgery). The importance of patient selection, ocular surface optimization, CME prophylaxis, and addressing pseudophakic dysphotopsias and residual refractive error were stressed. Strategies for IOL fixation for secondary implants and in patients with pseudoexfoliation syndrome were presented. Other talks included surgery in patients with concomitant eye diseases such as macular degeneration, dry eye, keratoconus, and corneal transplants. Another highlight of the meeting was the surgical complication video symposium. My favorite presentation was Dr. Jay Pepose’s review of the Elenza electro-active diffractive IOL that provides accommodation without movement. It is a monofocal IOL with a smart electro-active diffractive liquid crystal that allows for near focus by detecting changes in pupil size and illumination during accommodation.
Glaucoma
Glaucoma presentations were organized into two parts. There was a mini-symposium on phaco in eyes with glaucoma moderated by Drs. David Chang and Roger Steinert, which covered the effect of phaco on glaucoma, steroids to reduce the risk of IOP response, IOL selection, patient selection for combined surgery, and experience with MIGS. The other glaucoma session, moderated by Dr. Joel Schuman, consisted of talks about imaging modalities, genetic studies, home IOP monitoring, laser treatment, combined surgery and MIGS, and concluded with a surgical video symposium.
Retina
Dr. Andrew Schachat moderated the retina update. The panel of speakers, which also included Drs. Daniel Martin and Michael Ip, discussed the current recommendations for the management of dry and wet macular degeneration, diabetic retinopathy, and postoperative endophthalmitis.
Ocular surface disease
Management of the ocular surface was divided into two parts. Part 1, moderated by Dr. Michael Raizman, covered conjunctivalchalasis, endothelial keratoplasty techniques, the use of bandage contact lens and amniotic membrane, managing recurrent erosion syndrome, and the impact of medication vehicles. Part 2, moderated by Dr. Terry O’Brien, included talks on the treatment of dry eye, blepharitis, and ocular allergy, new data on dry eye studies, and topical ganciclovir for herpes keratitis and epidemic keratoconjunctivitis.
Refractive surgery
This session, moderated by Dr. Richard Lindstrom, consisted of numerous papers on all aspects of refractive surgery and concluded with a mini-symposium on corneal cross-linking. Topics discussed in the main session included PTK, PRK and LASIK (preoperative imaging, quality of vision, impact of tear osmolarity, pearls for the non-refractive specialist, managing epithelial ingrowth, ectasia risk), phakic IOLs, refractive lens exchange, laser cataract surgery, surgical keratoscopy and wavefront aberrometry, and presbyopia treatment with IOLs (design, refractive outcomes, quality of vision, enhancements), corneal inlays (specifically the Kamra inlay) and the scleral spacing procedure. In the corneal cross-linking session, speakers reviewed this topic in detail presenting talks on the basics, current status, advantages/disadvantages, techniques of epi-on and accelerated CXL, and future applications of the procedure. The morning concluded with a talk on compounding pharmacies and fungal endophthalmitis and meningitis.