This years congress
(14-15 May) was our most successful ever and marked our 10th
anniversary. It was held for the first time at the Royal College of
Physicians, London.
180 delegates attended of whom two thirds were ophthalmologists. 18% of
refractive surgeons have now undergone refractive surgery – a massively
higher percentage than that found in the general population, reflecting
the confidence surgeons have in modern procedures. Many of these
individuals were attending the conference and talked about their
experiences of the procedure and visual outcomes.
This year’s BSRS debate
‘This house believes that the rise in the number of high street clinics
will reduce the standard of refractive surgery provision in the UK’
started off the conference. Mr Sunil Shah,
President, and Mr. David Cartwright
,Professional Services Manager, Boots presented their arguments.
The debate with audience
participation centred on the commercial ethos and lack of ‘adequate’
clinical continuity of ‘high street clinics’ which compromised
clinical outcomes.
The counter was the
multidisciplinary environment of work in ‘high street clinics’ is
perhaps more likely to identify poor practice. Also salaried surgeons are
not commercially driven to treat ‘all’ patients.
Without complete
information of complications and why they arose this debate will continue.
The Against vote narrowly passed.
Mr.
Christopher Liu, consultant ophthalmologist, presented Medicolegal
aspects of refractive surgery. Laser refractive surgery is forming a large
part of ophthalmic claims. This may be due to the large volumes done along
with unrealistic patient expectations and failure of informed consent.
Signing each section of the consent form is not enough. The Surgeon must
show that they have talked through each section. All treatment options
should be discussed by the surgeon even if the alternative treatments are
not offered.
Surgeons, who take
overall responsibility, should delegate tasks only to competent
individuals.
Mr.
Bill Aylward’s (consultant ophthalmologist) talk concluded that
LASIK doesn’t cause retinal problems and dilation for routine LASIK
cases is not indicated from a retinal perspective.
One whole
afternoon was dedicated to state of the art wavefront technology by the
representative companies. All agreed that wavefront results were
encouraging but that it was not suitable for everyone. Most agree that
optimisation of current treatment, reduction of aberrations from primary
treatment, is needed more so than customisation.
All the speakers were to
be congratulated on the quality of their talks. Professor
Charles McGee one of the original founders returned to give a
comprehensive account of the benefits and limitations of Orbscan along
with identifying and avoiding complications of corneal refractive surgery.
Professor
Charles McGhee from Auckland (founder of BSRS) and fellow surgeons Sheraz
Daya, Anant Sharma and Sunil Shah (president of BSRS) just before the
annual dinner.
Prof
Bernard Gilmartin gave a thorough account on Myopia: biometric,
oculomotor and environmental aspects of onset and development.
Ioannis
Aslanidis delivered an exciting talk on EpiLasik. The formation of
an alcohol free epithelial flap using a special ‘Keratome’. This
ensures a healthier epithelial flap with the avoidance of 3rd
and 4th order aberrations from a LASIK flap.
Alternative non laser
technologies included Permavision intracorneal lenses and Artisan phakic
lens presented by Mr. Jan Venter
New technologies such as
femtolaser to cut corneal flaps and solid state surface ablation laser
(213 nm) were presented by Dr. Paul van Sarloos
This year’s LASIK \ PRK
\ LASEK presentations focused on avoiding and treating flap problems and
the use of mitomycin to avoid haze. LASIK to treat post operative
ametropia following keratoplasty, vascularised corneas leading to
interface haemorrhage and subsequent problems, fluorescein staining to
monitor epithelial ingrowth and contact lens fitting post PRK and LASIK. Mr.
Stephen Doyle spoke of his experience of less haze with LASEK than
PRK. He suggests considering LASEK if cornea too thin (<500um), large
pupils , loose epithelium or dry eyes.
The conference ended with
Bill Harvey’s presentation of the Optician
laser clinic survey 2002.
General
view of the congress hall
