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Orbis Chairman Robert Walters denounces manual small incision cataract surgical training strategy by Help Me See - 23 September 2010
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Orbis Chairman Robert Walters denounces manual small incision cataract surgical training strategy by Help Me See - 23 September 2010

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In a scathing attack, Orbis Charity Chairman, Rober Walters denounces the Help Me See organisation and the support to Manual Small Incision Cataract Surgery.

In a scathing attack, Orbis Charity Chairman, Rober Walters denounces the Help Me See organisation and the support to Manual Small Incision Cataract Surgery.

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  • 1. Statement by John J McHale – Interim CEO and Robert Walters, Chairman on the Support of Association of Cataract and Refractive Surgeons to Help Me See, the new organization launched by AL Ueltschi – 23 September 2010 Following the Joint APAO-AAO Meeting in Beijing from September 16-20th , the ASCRS publication listed below reported misinformation about ORBIS. It was sent out to approximately 13,000 people who attended this year’s meeting of leading international eye specialists. Rest assured that this misinformation has been brought to the publisher’s attention at the ‘Eye World’ publication. The following statement from Rob Walters provides clarification. Please be advised that only members of the ORBIS communication teams and approved ORBIS spokespersons should be talking to the press. The Communications staff in the U.S. and the UK will oversee and direct all communications regarding this matter and debrief the approved spokespersons accordingly. _______________________________________________________ John J. McHale President and CEO | ORBIS International 520 8th Avenue, 11th Floor New York, NY 10018 P. 1.646.674.5504 | F. 1.646.674.5599 | www.orbis.org ORBIS INTERNATIONAL EXPANDS ITS OPERATIONS WORLDWIDE BUT DROPS THE IDEA OF A 'PILOT TRAINING CATARACT SURGICAL SIMULATOR' By Robert F. Walters, Chairman of the ORBIS International Board of Directors and Member of the Board of Directors of ORBIS UK ORBIS International wishes to clarify the position regarding a new charity called 'HelpMeSee' as there has been some confusion. 'HelpMeSee' is in no way affiliated or connected with ORBIS. ORBIS considered the viability and cost effectiveness of the cataract surgical simulator (based on aviation flight training simulators) concept being proposed by HelpMeSee and decided not to implement the project. Mohan J. Thazhathu, a former administrative employee of ORBIS International who left the organisation in July 2010, decided to take the concept forward and ORBIS wishes him success in this venture. ORBIS continues its sight saving work with an interest in cataract surgical training. We are especially encouraged by the recent successful development of new inexpensive artificial eyes for cataract surgical training such as those featured at the recent European Society of Cataract and Refractive Surgeons meeting in Paris and we will follow these developments closely. This year, ORBIS will carry out eighty major sight saving projects in sixteen countries in the developing world, forty five Hospital Based Training Programmes and eight Flying Eye Hospital programmes. Our online teaching tool, Cybersight, continues to expand and we will be deploying 150 volunteer doctors and nurses to our projects this year.
  • 2. Africa has the greatest need for eye care of any continent and Sub-Saharan Africa has the highest prevalence of blindness in the world. For this reason, we have decided to expand our office in Ethiopia to cover Eastern Africa. In addition, we are opening a new country office in Cape Town, South Africa which will concentrate on the development of programmes in the Southern African Development Community. Our new Flying Eye Hospital project is progressing and we are expecting that it will be available to contribute to our worldwide mission within the next 12-18 months. Meanwhile the existing DC10 Flying Eye Hospital will continue its sterling role. http://www.eyeworld.org/email/10-Beijing/mr_bb_09192010.htm Today's news from the 2010 APAO meeting brought to you by EyeWorld magazine. Modified SICS Though manual small incision cataract surgery (SICS) is decidedly less advanced than phacoemulsification, practitioners who routinely use the former technique to manage cataracts are no less innovative. In a symposium on SICS held Saturday, Amporn Jongsareejit, M.D., described three modifications to the SICS technique which he uses for varying degrees of cataract: the "Amporn technique" for hard cataracts; the phacosection technique for moderate cataracts; and the phaco-drainage technique for soft cataracts. The Amporn technique basically involves removing the nucleus whole through the sclerocorneal tunnel after being popped out of the capsule into the anterior chamber. The phacosection technique adds a chop, cracking the nucleus into two before extraction. The most unusual of these procedures is the phaco-drainage technique, for which Dr. Jongsareejit invented a special nucleus removal tube. The technique uses the pressure from an anterior chamber maintainer to allow the nucleus to drain passively into the nucleus removal tube. Another modification to the basic SICS procedure is the fishhook technique, described at the same symposium by Bidya Prasad Pant, M.D. The technique, he said, was first described in 1997 at the Lahan Eye Hospital, Nepal. It involves making a "fishhook" out of a tuberculin syringe by bending the tip with a pair of pliers. Using the fishhook, the nucleus can be extracted directly out through the sclerocorneal tunnel without first pushing it out of the capsule into the anterior chamber.
  • 3. Cataract flight training Phaco is beyond the reach of 90% of people blind from cataract, said Mohan Thazhatu, M.D. Considering cost alone, if phaco were used in a major campaign to eliminate blindness due to cataract, it would cost around US$130 billion at current prices. An equivalent program using manual small incision cataract surgery (SICS) would cost just US$4.5 to 5 billion. Dr. Thazhatu is in the pilot phase of the Global Project for Elimination of Cataract Blindness of HelpMeSee, a spinoff organization of ORBIS International dedicated to the prevention and cure of blindness around the world. An additional advantage of SICS over phaco is a short learning curve. In fact, skills transfer with SICS is so easy that even non-ophthalmologists can be trained to perform the procedure. Still, a massive campaign on the scale of HelpMeSee imagines to eradicate cataract blindness requires a large number of participants—Dr. Thazhatu estimates they will need to train 15,000 to 18,000 cataract specialists to treat 38 million people in 10 years. To facilitate SICS training, Dr. Thazhatu and others at HelpMeSee are currently developing a cataract surgery simulator modeled on aviator training simulators. The advantage of such simulators, he said, is that they emphasize proficiency over procedure; it's possible for a trainee to step out of an aviator training simulator directly into the cockpit of a passenger jet. This isn't, of course, the plan for cataract surgeons. However, Dr. Thazhatu expects such a simulator to speed training along, facilitating the transition from classroom to hands-on wetlab training. Imagining the LASIK future Ioannis G. Pallikaris, M.D., who in 1989 performed the first LASIK procedure on a human eye, tried to imagine what LASIK lasers would be like in the future during a presentation at the 25th APAO Congress. He believes that other wavelengths of laser may be used in the future, such as infrared lasers. Recently in Paris, a nanosecond laser—which may work much more precisely than the femtosecond laser—was debuted, he said. FLEx (Carl Zeiss Meditec, Jena, Germany) technology is very interesting, he said, as instead of ablating the cornea, it allows a lenticle to be cut inside the cornea and then removed. "The future of LASIK development lies in the deeper understanding of every aspect of it," Dr. Pallikaris said. These facets include the optics, biomechanics, healing process, the limits of the technology, and other factors, he said. One great laser Minoru Tomita, M.D., Ph.D., meanwhile, virtually stood in awe of the Schwind AMARIS (Kleinostheim, Germany) excimer laser. He described it as a high ablation speed laser at 750 Hz. It also has more accurate ablative spot placement, he said. The laser also includes "6 dimensional eye tracking" and advanced cyclotorsion control, he said. He considers the laser to be for "premium treatment." In one study of 4020 LASIK eyes (used in combination with a femtosecond laser for flap cutting), Dr. Tomita said 96% of patients achieve 20/20 vision or better at 3 months postoperatively. He also said 99% of patients achieved corrected distance visual acuity of 20/20 at 3 months post-op. He described the laser as yielding excellent visual and refractive outcomes 1 day after the procedure. Part of the reason the laser works so well is that it is dedicated to both a high speed and high power ablation, but also ads in a lower power ablation feature that creates a smooth ocular surface. He also explained that while 2-D eye trackers may not track some minor eye movements—leading to inaccurate spot placement—6-D can compensate for these movements yielding more accurate positions. In Dr. Tomita's practice, the move toward the laser has been patient-driven. He said that in August 2009, only 689 patients had the procedure, while by July 2010, almost 11,000 cases were done.
  • 4. Getting corneal topography right Stephen Klyce, Ph.D., suggested that it's critical to get corneal topography correct in order to know which patients really are good refractive surgery candidates—and which aren't. It's also important to ensure appropriate topographically-guided treatments, he said. Of course, risk factors for corneal ectasia include abnormal topography, high myopia, reduced preoperative corneal thickness, and other factors, he said. Abnormal topography is a very critical risk factor that simply cannot be ignored. Placido topography works by projecting mires on a corneal image, and then a computer determines the position of those mires and ascertains an axial power map, he said. Slit tomography, meanwhile, obtains multiple slit images of the cornea. These are determined by a computer to show the positions of the anterior surface, posterior surface, iris, and other features. It's a powerful device to determine corneal thickness and anterior chamber depth, he said. Still, Dr. Klyce said, the measurement sensitivity of placido topography is 20 times than of slit-based tomography. In one study, Dr. Klyce explained that a slit tomography device (the misclassified normal corneas. Forty- one corneas were determined to be normal by a placido topography device, and yet 23 of them were misclassified by the slit device (of which, 9 looked like they had myopic refractive surgery, 7 looked like they had keratoconus suspect, and another 7 were unclassifiable, but looked irregular). In an even larger study of 119 eyes, 62% were judged by the slit tomography device to be "not normal," he said. Again, 29 were found to mistakenly be abnormal, 1 was wrongly found to have keratoconus, and 27 were incorrectly judged to have keratoconus suspect. "That's a huge false positive," Dr. Klyce said. "When we had a true positive keratoconus suspect, the surgeon didn't know whether to believe it or think it's a false positive." Some devices have both placido topography combined with slit tomography, and Dr. Klyce seemed to be a fan of those devices. Slit tomography is not as sensitive to data loss on aberrated corneas, he said. © 2010 EyeWorld Having trouble viewing this email? Paste this link into your browser: http://www.eyeworld.org/email/10-Beijing/mr_web_09192010.htm