SFO meeting covers issues in all branches of ophthalmology

Vitreous pathologies were the focus of this year’s annual report.

PARIS — With nearly 4,000 attendees, 80 exhibitors and more than 600 presentations, round tables, wet labs and symposia taking place in the rooms of the Congress Palace, the annual meeting of the French Society of Ophthalmology was indeed a heavily populated event.

The SFO is the largest medical association in Europe, counting 7,000 members in France and other European and non-European countries, including many representatives from French-speaking African nations.

“We are constantly improving and intensifying our relationships with foreign associations, in particular with Belgium, Germany, Italy and Great Britain in Europe, with north and west African countries, and with parts of the Middle East,” said Jean-Louis Arne, MD, president of the association. “A series of joint initiatives in various fields of research and education are being carried out thanks to this cooperation.”

The scientific sessions of the meeting covered issues in all branches of ophthalmology. This article presents a brief overview of meeting highlights, not a comprehensive review.

Vitreous, heart of the eye

The yearly report, presented by Gérard Brasseur, MD, focused on the vitreous, “the heart of the eye,” as he defined it. The vitreous body plays a role in many ocular pathologic conditions, he said, and vitreous surgery has a wide series of indications.

The diagnosis and treatment of vitreous and vitreous-related pathologies, such as proliferative vitreoretinopathy, vitreous hemorrhage, macular hole, pathologic myopia and retinopathy of prematurity, have improved tremendously in the past few years, said Prof. Brasseur. This is the result of sophisticated imaging techniques, including ultrasonography and optical coherence tomography, to increasingly finer microsurgery instruments and to the better quality of vitreous substitutes.

Another important area of research is pharmacological treatment of some forms of maculopathy and retinopathy through intravitreal injection.

“In the vitreous body, medications maintain a constant concentration, without secondary effects,” Dr. Brasseur said.

Fighting AMD

Age-related macular degeneration is an increasing concern among ophthalmologists with the aging of the population. Some presenters said photodynamic therapy (PDT) is proving to be less effective in the long run than initially believed.

“We can honestly say that PDT stabilizes visual acuity in about 50% of the cases of the wet form of AMD with predominantly classic lesions. On the other hand, not all forms of AMD can benefit from the treatment,” said Gisèle Soubrane, MD.

In AMD with occult choroidal neovascularization, alternative forms of treatment have had limited success, Dr. Soubrane said. Among them are feeder vessel treatment using laser photocoagulation and transpupillary thermotherapy. The latter is showing an unexpectedly high rate of complications, and the anatomic and functional positive response to the treatment is not always perceived as a subjective improvement by the patients, according to some studies, she said.

New and promising perspectives for AMD treatment include the use of antiangiogenic agents, such as anti-vascular endothelial growth factor (VEGF) drugs and anecortave acetate, alone or in combination with PDT.

“These methods are currently under investigation to demonstrate their efficacy,” Prof. Soubrane said.

On the other hand, the role of antioxidant and zinc supplementation in reducing the rate of progression of AMD, as demonstrated by the Age-Related Eye Disease (AREDS) study, is “some of the best news concerning this pathology,” she said.

Diabetes on the increase

Diabetes is also a growing concern in developed countries. The increasing incidence of the disease is largely due to the changes in the environment and, in particular, to modern eating habits, according to Dominique Chauvaud, MD.

“In the industrialized countries, diabetic retinopathy is at present the first cause of blindness among individuals younger than 50 years of age,” she said.

A round table on diabetic retinopathy at the SFO concentrated on the pathogenesis of the disease and on the new treatments available. Genetic factors and other factors specifically related to ocular tissues are currently becoming better understood, participants said. Corticosteroid therapy followed by scatter photocoagulation are still the gold standard for treatment.

New ways of dealing with retinal edema, the most difficult to treat among the many complications of diabetic retinopathy, were discussed at the symposium.

Intravitreal injection is currently being explored as an alternative method of administering medications, and as a way to avoid the risks of iatrogenic damage from photocoagulation. It is a valid alternative, according to recent studies, because with lower systemic absorption, corticosteroids do not alter the glycemic levels and do not affect the untreated eye.

Other studies promoted the use of photocoagulation with yellow laser instead of green argon. Because a lower energy and a shorter delivery time are used, yellow laser seems to produce fewer alterations of the retinal pigment epithelium, presenters said.

Artificial vision progressing

A symposium on artificial vision revisited the principal achievements of both cortical and retinal implants.

“Research in this field is making slow but constant progress. Using the spectacular advances of modern technology to replace the eye is yesterday’s dream that today appears more and more realistic. However, the results we have achieved are still experimental,” said Costantin Pournaras, MD.

Promising methods and devices for helping low-vision patients are emerging, and advances have been made in the understanding of brain responses to stimuli that can lead to partial rehabilitation of vision in some of these cases.

Wide variety of IOLs

Advances in IOL technology have mainly developed in two directions, presenters said: preventing complications and contributing to better vision. Materials and designs have contributed to these results.

Studies presented during the meeting focused on long-term results with a variety of IOLs, including accommodative models. Other speakers presented more recent products, such as the Alcon’s AcrySof Natural lens, which is designed to protect the retina from damage from blue light; the Concept lens by Corneal, which stretches the capsule like a tension ring and blocks cell migration; and the new foldable scleral fixation Ultima IOL, also by Corneal.

A review of phakic IOLs was given by Jorge Alió, MD. He said that our knowledge of the behavior of these implants in the eye is now sufficient to make informed choices of what is best for each patient.

“My preference goes to angle-supported lenses for myopic patients and to posterior chamber lenses for hyperopes,” he said.

Sizing problems with angle-supported lenses will soon be a thing of the past, he said, because of the development of the Artemis technology from Ultralink. The device is at present only used in a few centers, Dr. Alió said, but in the future a decrease in the price of the technology may make it available to more surgeons.

“As far as presbyopia is concerned, my bet is also for phakic implantation, which is a reversible procedure. Results with the presbyopic Array are tremendously encouraging,” he said.

Laser photoablation

Laser refractive surgery, and LASIK in particular, was a main topic in the training courses conducted during the meeting. It was also widely discussed in the symposia of the French society of refractive surgery (SAFIR), running in parallel with the principal SFO meeting.

Several manufacturers’ microkeratomes, lasers and aberrometers were compared, and wavefront-guided ablation was seen to be increasingly gaining favor among surgeons.

“All the different wavefront techniques presented here are not necessarily superior to conventional treatment as far as visual results are concerned, but the quality of vision is better. Patients have less glare, better contrast sensitivity and fewer problems with night driving,” said Joseph Colin, MD.

Depth of ablation was a hot topic for discussion. Some surgeons said conventional treatment spares more tissue than customized ablation.

“If we want to correct all the aberrations, it is likely that we remove a greater amount of tissue, and this is something that must be taken into consideration. We should find the right balance between achieving the best possible correction and sparing as much tissue as possible,” Prof. Colin said.

Wavefront correction as a secondary procedure was unanimously recognized to be promising, although some limits do exist with the currently available technology, presenters said.

“Most wavefront analyzers cannot work if the astigmatism is too high, which is quite a frequent situation in patients who need a secondary procedure. However, this technology is rapidly improving, and we are in the right direction for much better results in the future,” Prof. Colin noted.

Emergence of developing countries

Middle Eastern and African countries were represented in many of the meeting sessions. Even the countries with the poorest means were able to produce remarkable studies and reports on the conditions of their populations with regard to various ophthalmological issues. The presenters demonstrated how local physicians are making considerable efforts to improve health and quality of life in deprived areas.

Two young ophthalmologists were awarded the annual grant for French-speaking foreign candidates. They reported on the conditions of the very young and the elderly, respectively, in Mali and Togo.

Keita Fatoumata Sylla, MD, described the emergence of a surprisingly high incidence of ocular trauma in children, due to the fact they cannot be properly looked after, and to the uncontrolled use of dangerous objects in their games.

“If prevention is a problem, treatment is also an ordeal. We are unable to properly manage the high number of these patients, due to the lack of medical staff in our hospitals, to the long distances, to the delay with which parents take injured kids to emergency because they underestimate the problem. It’s an everyday battle, and good will is often not enough,” she said.