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The OSNE300 Survey
The OSNE300 Survey is a group of 300 European surgeons regularly polled for their opinions on hot topics in ophthalmology. The surveys are sent monthly, 10 times a year, to those on the list. If you do not receive the survey and would like to be included, please contact Managing Editor Erin L. Boyle at eboyle@slackinc.com.
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What do you think is the hottest topic currently in ophthalmology?
Arthur Cummings
All you need to do to answer this question is to look at current publications and meetings, and everything is dominated by femtosecond lasers for cataract surgery. I find it interesting that this is the hottest topic given that the current benefits are so modest: slightly better corneal incisions, more accurate capsulorrhexis and better control of arcuate corneal incisions. The reason that the topic is so hot, however, is the promise of the potential that the future holds. These same lasers or iterations of these lasers with newer, truly accommodating IOLs promise the holy grail: a cataract procedure that fully corrects both the refractive error as well as presbyopia where it is needed, in the lens.
— Arthur Cummings, MD, FRCS
Wellington Eye Clinic, Dublin, Ireland
Disclosure: No products or companies are mentioned that would require financial disclosure.
For the cornea surgeon, it is definitely DMEK. DMEK restores the diseased corneal endothelium in a perfect way. The challenge is the way to get and prepare the donor membrane. You do not need a highly sophisticated high-priced machine — no laser, no microkeratome. You just prepare the donor membrane with instruments and a microscope. Also, the operation is done with normal surgical instruments. The result of a successful operation is outstanding and can restore vision much better than any other method when the corneal endothelium is sick. DMEK will replace DSEK over time.
For the glaucoma surgeon, the hottest topics are the new stents and shunts. Ex-PRESS (Alcon) and especially the iStent (Glaukos) are very helpful tools to treat uncontrolled open-angle glaucoma.
For the cataract surgeon, the hottest topic is femto-phaco-assisted cataract surgery. One thing it surely has is bias on both sides, which leads to poor scientific assessment of any benefits or lack thereof. It is currently a want-have machine but not a must-have machine. Patients will ask for the benefit. We currently have no scientific data or a true double-masked study with a predetermined result to be statistically assessed. This should be what all involved groups are asking for. The study should be separated into different areas like outcome of incisions, capsulotomy, phacoemulsification power and time, and refractive outcome. This study should not be supported by a specific company but the same way as the CATT, involving Lucentis (ranibizumab, Genentech) vs. Avastin (bevacizumab, Genentech). This technology deserves a true outcome analysis to either support the technology or refute its worthiness.
— Tobias H. Neuhann, MD
Medical Director, AaM Augenklinik, Munich, Germany
Disclosure: Dr. Neuhann has no relevant financial disclosures.
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What subspecialty in ophthalmology do you see having the most innovation and revolutionary paradigm shift in the next 10 years?
Femtosecond cataract surgery and new IOLs are going to dominate the next 10 years in ophthalmology, putting cataract and refractive surgery at the forefront of ophthalmology. Improvements in femtosecond surgery with total liquefaction of the crystalline lens and aspiration of the bag contents through a tiny, sealable opening will become possible in the next 10 years. Replacing the crystalline lens with a gel substance that can move and thus accommodate will allow surgeons to correct the refractive errors as well as address presbyopia at the site where it occurred in the first instance.
— Arthur Cummings, MD, FRCS
Wellington Eye Clinic, Dublin, Ireland
Disclosure: No products or companies are mentioned that would require financial disclosure.
Tobias H. Neuhann
That is hard to say.
As a cataract surgeon, I am waiting for a true accommodating IOL. There are a lot of possibilities in the pipeline. Theoretically we all know how the accommodating IOL should work: filling the capsular bag with a well-defined flexible solution — perhaps silicone — and letting the ciliary body do the rest. Only secondary cataract will stop this development. So secondary cataract formation has to be solved first before we can move to the accommodating IOL. In the meantime, I will love to see further development in light-adjusting IOLs.
For a retina surgeon, there is the new biotechnology of implanting intelligent microchips in patients with severe visual loss.
— Tobias H. Neuhann, MD
Medical Director, AaM Augenklinik, Munich, Germany
Disclosure: No products or companies are mentioned that would require financial disclosure.