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A look back at OSN shows constancy as well as progress
As part of the celebration of our 20th anniversary, we page through the first issue of Ocular Surgery News.
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THOROFARE, N.J. — Cataract surgery has undergone a revolution and refractive surgery has moved from margin to mainstream since this publication debuted as IOL and Ocular Surgery News in January 1983. 
But to a surprising degree the profession has remained constant. A look back at our first issue shows this. Posterior capsular opacification is a concern now as it was then. Cystoid macular edema is still an issue. And surgeons are exploring the economics of owning an ambulatory surgery center as they were 20 years ago.
But the overriding constant is the profession’s spirit of innovation. Whether learning the intricacies of the Nd:YAG laser in 1982 or the latest in wavefront diagnosis in 2002, ophthalmologists are eager to get their hands on new technology in the hope of benefitting their patients.
Joint meeting
The first issue of OSN contained a number of reports from the 1982 meeting of the American Academy of Ophthalmology, including a combined session with the American Intra-Ocular Implant Society (now the American Society of Cataract and Refractive Surgery).
At the combined meeting, Manus Kraff, MD, moderated a panel discussion on the recent growth in extracapsular cataract surgery. His opening remarks give a good indication of the state of cataract surgery in 1982.
“A major change has occurred in cataract surgery as we know it over the past 10 years,” Dr. Kraff said. “Back in 1977, cataract surgery performed by intracapsular cataract extraction (ICCE) was almost 98% of the surgery being performed, whereas about 2% to 5% of the cataract extraction was being performed by extracapsular means.
“Today, there’s a great increase in the amount of extracapsular cataract extraction (ECCE), whereas ICCE has markedly decreased. Walter Stark yesterday presented his data from the FDA, showing that about 48% of the IOLs implanted are now done in the posterior chamber. This would probably translate to about 40% to 45% of total cataract extraction.”
The panel members, including David J. McIntyre, MD, Stephen A. Obstbaum, MD, Walter J. Stark, MD, and Richard P. Kratz, MD, indicated that they had moved to ECCE over the past 10 years, in some cases abandoning phacoemulsification for the extracap approach.
Dr. McIntyre, developer of the manual irrigation and aspiration technique that bears his name, said he moved from phaco to ECCE when he began implanting IOLs.
“I did not implant over phaco,” he said. “If I was going to open the eye to put in an implant, there was no reason for me to accept the extra difficulties, hazards, complications and expenses of doing the high-technology, mechanical thing with the rather unsophisticated machinery we had available at that time (1975). So I made the transition to planned extracap then.”
Obviously phaco technology has come a long way since 1982.
ASC economics
In a separate article, Dr. McIntyre discussed the economics of operating an ophthalmic ambulatory surgery center. At that time, there were about 25 such centers in the United States, and rising interest had led to the formation of the Outpatient Ophthalmic Surgery Society, of which Dr. McIntyre was secretary.
He said his surgical volume was about 45 cataract/IOL patients per month, but he estimated that volume as low as four or five patients a week could support such a facility. This was of course in the era before cataract fees were adjusted downward.
Dr. McIntyre said his clinic’s average patient charge in the first quarter of 1982 was $221, not including the IOL. This compared to a 24-hour hospital stay with comparable services at an average of $1,110, he said.
YAG trials begun
An article starting on page 1 described another symposium at the AAO meeting at which Daniel Aron-Rosa and others discussed their experience with the Nd:YAG laser for posterior capsulotomy.
“The century of the cutting laser is opened,” Dr. Aron-Rosa said.
A short article later in the issue announced the beginning of an FDA investigation for approval of the YAG laser from American Medical Optics for posterior capsulotomy.
The capsule and CME
In an article on management of cystoid macular edema (CME), Dr. Obstbaum said there was “a very strong feeling” among many surgeons that preservation of the posterior capsule might have a role in preventing CME.
Other articles in the issue presented the pluses and minuses of posterior and anterior chamber IOLs, discussed the effects of patient variables on the outcomes of ECCE and phaco, prepared surgeons for the transition from ICCE to ECCE and outlined the differences between sodium hyaluronate and chondroitin sulfate as viscoelastic materials.