Orbis Chairman Robert Walters denounces manual small incision cataract surgical training strategy by Help Me See - 23 September 2010
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
John J. McHale
President and CEO | ORBIS International
520 8th Avenue, 11th
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
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.
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.
Today's news from the 2010 APAO meeting brought to you by EyeWorld magazine.
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
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.
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
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.