For yet another year, Hawaiian Eye was a success, with a great attendance at a fantastic location. At the Hyatt Regency and Westin on Ka’anapali, Maui, the sun was shining, the waves were crashing and the whales were jumping. We couldn't have hit the weather more perfectly! The trade winds that blew through the meeting hall were a refreshing reminder of how lucky we all are to be ophthalmologists!!
The meeting started off on Sunday, January 16 with a session on the business of ophthalmology. Afterwards, the hallway resonated with belly laughs that were coming from the conference room where Jack Holladay, Uday Devgan, and Marguerite McDonald among others presented their thoughts on lifestyles laughter…. a hard act to follow for the following session. Oh yah, that was me!
For the first year, Hawaiian Eye featured a spotlight symposium on cosmetic and eye plastic surgery. This section was moderated by myself and covered topics that every comprehensive ophthalmologist needs to know. I started the symposium with a talk on upper eyelid blepharoplasty. Work up, step-by-step surgical procedure and complications were discussed. Next were eyelid malpositions, including how to recognize and treat ectropion and entropion. With these first 2 talks, surgical pictures were key in demonstrating the treatments. Dr. Joely Kaufman, assistant professor of dermatology at the University of Miami, then gave a talk on botulinum toxins that were relevant to the comprehensive ophthalmologist. We showed a series of videos to demonstrate the different techniques of injection. I finished the symposium with a talk on treatment of eyelash hypotrichosis. Key elements of this talk were the differences between different eyelash enhancers with a particular focus on the only FDA approved product, Latisse.
Monday's talks focused on cataract surgery with highlights on advances in techniques and technology. Dr. Jack Holladay discussed negative dysphotopsia with an optical explanation and clinical consequences of square edge optics. Dr. Randall Olson discussed a new system of intraocular micro-camera and surgical instruments. This micro-camera has a disposable, flexible light fiber optic video camera with attached instruments. The camera can go anywhere in the eye and magnifies up to 200x with a 360 degree controlled bend tip. Tools of this sort should change the way we visualize inside the eye and can all be done through a small 0.6mm incision.
Tuesday began with a panel discussion on cataract surgery complications. In the late morning, Dr. Sonia Yoo moderated a discussion on refractive surgery complications. Videos, faculty interaction, audience response and didactic presentations were used to discuss challenging cases that were presented by the experts.
Then followed a mini symposium on vitreoretinal issues for cataract surgeons. Preoperative assessment of the macula, cataract surgery in ARMD and diabetic retinopathy patients, pseudophakic retinal detachment, pitfalls of anterior vitrectomy by an anterior segment surgeon and recommendations for CME prevention and treatment were all discussed.
One of the hot topics not only at this meeting, but also amongst ophthalmologists in general of late is femtosecond laser cataract surgery. Dr. Michael Knorz from Germany, presented his experience using femtosecond laser. What he found was that the capsulorhexis was perfectly centered and highly reproducible in all cases, as opposed to manual rhexis in which only 10% achieved a diameter accuracy of +/-0.25mm. Femtosecond also results in more efficient lens removal with a 46% reduction in Phaco power. There was a 28% reduction in endothelial cell loss compared to the Phaco group. Laser also reduced the variability in effective lens position.
Wednesday was glaucoma day with talks ranging from genetics, whether landmark studies bear importance to new technology. Dr. Anne Coleman gave a talk on glaucoma surgical trends in the United States. She stated that there has been an increase in surgery rates in areas of innovation, such as SLT, endoscopic cyclophotocoagulation and drainage devices. There is also increased diagnostic testing in areas of innovation. Her bottom line is that innovation is great if it leads to better outcomes for patients.
Thursday focused on retina and ocular surface. Dr. Andrew Schachat gave a talk on the treatment of diabetic macular edema: choosing and using laser, anti-VEGF or steroids. He determined that laser is effective and safe, requiring fewer treatments and visits although it may take years for maximal efficacy. Steroids are effective with some safety concerns. There was also no benefit in studies versus laser. Anti-VEGF treatment is effective and has fewer safety concerns. Laser plus anti-VEGF is better than laser alone.
Dr. Jay Prepose discussed a new "Lab on a Chip" Device that tests tear osmolarity in 50 nanoliter samples without causing reflex tearing. The importance of this device is that tear osmolarity is the single test that best correlates with dry eye severity, a disease that affects so many across the world.
Finally, Friday's focus was refractive surgery. One of the talks that stood out was by Dr. Daniel Durrie who presented "When Corneal Cross-linking is Approved-Who will be the Best Candidates?". The best candidates for corneal cross-linking seem to be those with a diagnosis of progressive keratoconus, age <35 yrs, corneal thickness >400 um, max K <58D, and BCVA worse than 20/25. Dr. Durrie states that physicians with extensive cross-linking experience have suggested that the goals for successful outcomes are early identification of keratoconus and early corneal cross-linking treatment.
That sums up some of the highlights from the meeting. We all left the island, macadamia nuts in hand, trying to fight the depressive thoughts of returning to work but with excitement and anticipation for next year which will take place again on Maui, January 15-20 at the Grand Wailea Resort & Spa, another spectacular venue.