From May 25 to 29, the congress of the American Society for Refractive Surgery and Cataracts (ASCRS), one of the most important events of the year, where the most notable developments of the moment are presented and a debate is held about the follow-up of the studies in progress, before they are applied in a general way to the population.
In this framework of coexistence, with more than 10.000 attendees from all over the world, we had the opportunity to share experiences and attend multiple presentations, among which it is worth highlighting novelties such as the new optical quality analysis systems and aberrometry incorporated into surgical microscopes, to obtain information during surgery and thus be able to adjust the power and position of the intraocular lenses in the capsular bag. Along these lines, it is also worth highlighting the advances in new calculation formulas for intraocular lenses and new equipment for the study of the optical structures of the eye, based on "adaptive optics", where Spanish researchers are world leaders.
Laser cataract surgery
Special mention deserves the follow-up in the development of the platforms laser for cataract surgery, a technology that does not seem to start definitely. The high cost and the few advantages over ultrasound systems, slow its incorporation in the surgical rooms, although there are great defenders that promote its use, yes, some of them already know them for their high commercial interest in everything that defend.
In the field of the cataracts, if it seems that mulitfocal lenses are gaining adherents, especially trifocals, to correct far, near and medium distance vision. The new designs offer better and more predictable results.
The use of intracameral antibiotics during surgery, cefuroxime and now moxifloxacin, show the advantages in preventing postoperative infections, the dreaded endophthalmitis, to the point of not presenting differences in the simultaneous bilateral surgery groups of both eyes and when the surgery of one and the other eye separates on different days.
Corneal treatments
En cornea surgery highlights the advances in lamellar techniques, with great improvements in the instruments for transplantation endothelial DSAEK and DMEK, as well as in deep anterior lamellar transplants. En el keratoconus highlights the new systems of crosslinking with microwave (Avedro) and by iontophoresis, accelerating the process of realization and improving its effectiveness.
Dry Eye
In the area of the ocular surface and the Dry Eye, highlight the new systems of analysis of the tear film and meibomian glands (meibography), section in which we could contribute our experience and the results obtained with the probing of these glands, especially in cases of Dry Eye evaporative. Also worthy of note are the new drugs, eye drops, which improve the quality of the tear film as well as the importance that treatment with oral omega-3 supplements seems to take, but in its re-esterified form (rTG), compared to traditional formulations. (ethyl ester), with less intestinal reabsorption capacity and with it, less therapeutic efficacy.
Presbyopia
Finally, the issue of presbyopia treatment, on which multiple presentations and courses focused. Next to the mulitfocal lenses, the new ones stood out intracorneal implants (inlays) and especially scleral systems, such as Refocus. A correction mechanism based on Goldberg's theory of accommodation and its loss with age is sought.
The objective is to use a system that corrects both eyes, that does not impair vision from a distance, that is reversible and that it does not "touch" any structure of the visual axis. With these premises, Refocus scleral implants gain acceptance, since it is the only system that fully complies, as was shown by the majority of groups that are investigating in this campor, as in our case, that we presented our experience, pointing out the advantages already mentioned and the spectacular improvement in the surgical technique, which greatly facilitates its implantation, with an almost immediate recovery of the patient.
Conclusions
They are not great advances but the final balance is very positive, improvements in the diagnostic and therapeutic systems are appearing and a positive critical attitude is appreciated on what the doctors did not see clearly and on what there was pressure from the commercial houses to impose it. I am left with the fact of seeing how logic and reason prevail over certain interests that are not strictly medical.
