Best of the best at 37th ESCRS Congress

One of the more unusual events at the 37th Congress of the ESCRS in Paris involved some 2,000 ophthalmologists standing in unison for a course of stress-relieving breathing exercises led by Denmark’s Stig A Severinsen MsC, PhD. “These are very simple breathing techniques you can use the next day. It was amazing to see from the podium,” said Oliver Findl MD, of Hanusch Hospital, Vienna, Austria, who co-chaired the “Surgeons Under Stress” main symposium following the Congress’s opening ceremony and Binkhorst Medal Lecture on Sunday morning. Relaxed surgeons help relax patients and vice versa, and that makes surgery less stressful for both, according to anaesthesiologist Andrew Presland FRCA, of Moorfields Hospital, London, UK. Counselling patients in advance about exactly what they can expect in terms of pain and what they will experience can improve cooperation and outcomes. Quantitative research by Stefan Palkovits MD, also of Hanusch Hospital, showed stress during cataract surgery peaks at cracking the nucleus and declines as phacoemulsification concludes. “You know that once you have the crack you are nearing the end,” Dr Findl explained. Other presenters addressed effectively managing stressful complications, including capsulorhexis run-outs, constricted pupils and wobbling lenses. Yet practical as such guidance can be, it took some work convincing the Congress Programme Committee to tackle surgeon stress, Dr Findl said. That the Committee approved and attendees embraced it demonstrates the value surgeons find in the innovation, practicality and rigour that have become the hallmark of ESCRS meetings. “It’s not just about technology and technique, but about doctors. Most of the outcome is connected to the behaviour of surgeons managing surgery. It is a nice way to think about it; it is different and very successful,” said Professor Béatrice Cochener-Lamard MD, PhD, of the University of Brest, France. Cutting-edge science Excellent research is another reason why many surgeons consider the ESCRS meetings among the best in the world, said Professor Rudy MMA Nuijts MD, PhD, of Maastricht University, the Netherlands. “People are very sensitive to the quality of what is being conveyed on the podium and we stand out there.” The 2019 Binkhorst Medal Lecture on innovation by Israel’s Ehud Assia MD is a good example, Prof Nuijts said. In it, Dr Assia described fixating an intraocular lens to the sclera combining the Yamane technique with a Prolene 6-0 suture. “It’s nice to see what has changed.” For IOLs, new randomised trials suggest that new extended range of vision lens may provide better intermediate vision using an elegant wavefront approach that does not create the optical disturbances seen with many multifocal and even extended depth of focus lenses. “If true, this is a whole new area of IOLs opening up,” Dr Nuijts said. The depth and variety of the four main symposia, the four research symposia and the debate format Journal of Cataract and Refractive Surgery symposium solidly anchor the scientific programme, said Professor Thomas Kohnen MD, PhD, FEBO, of Goethe University, Frankfurt, Germany. “If you look at these nine you get the whole story.” The greater freedom European surgeons have to test new devices means more cutting-edge research is on hand than at some meetings in the USA, Prof Kohnen added. Instructional courses also are rigorously evaluated and updated. “If they are not working, they are out. Several courses have evolved over the years.” Collaboration with other international societies further strengthened the Paris programme, said Soosan Jacob MS, FRCS, DNB, of Dr Agarwal’s Group of Eye Hospitals, Chennai, India. She cited talks from the International Society of Refractive Surgery symposium. Brad Randleman MD spoke on Brillouin microscopic studies of corneal biomechanics that demonstrated the effectiveness of contact lens-assisted corneal cross-linking for treating thin corneas. Scott MacRae discussed femtosecond lasers to induce refractive index changes in the cornea, and Dr Jacob presented her own research on corneal allogenic intrastromal ring segments to replace synthetic materials. Other cutting-edge papers Dr Jacob noted include a report on the vRESPOND study that attempted to trace the path of light in patients with negative dysphotopsias and create a virtual refractive surgery application to treat it. The NECSUS study aimed to identify IOL characteristics that may trigger neuroadaptation. Gene therapy for hereditary diseases and tumours, and corneal endothelial cell regeneration for Fuchs’ dystrophy or bullous keratopathy were other promising technologies presented. Interactive experience Monday’s main symposium on artificial intelligence drew another big crowd, and was another example of innovation, Prof Cochener-Lamard said. “I confess that it was challenging to demonstrate to the ESCRS Board that AI, which is a current hot topic in the world, had reached a level of maturity sufficient in Ophthalmology to be the subject of a symposium; and without a doubt the meeting was a great success. Besides getting the science, it brought in how AI may change treatments and patient management and the job of being a doctor.” Compelling as new research is, it’s not the only reason the Paris meeting stood out this year, Prof Kohnen said. “It’s more the format that attracts people; the freedom of information, unlimited use of spaces in Europe and it is easy to fly.” The society’s emphasis on creating interactive experience is also a big factor, drawing 9,550 ophthalmologists and 14,000 attendees overall, he added. Similarly, because of the successful pilot approach of Free Paper Forum initiated by Prof Cochener in 2018, this year the model was generalised to all free paper sessions, which were held in a large room with several sessions running concurrently, with observers listening with wireless headphones. This allows smaller groups that encourage more interaction, and allows listeners to easily move from one session to another, an approach piloted last year in Vienna, Dr Findl noted. “With smaller groups people feel more free to interact. There were a lot more questions and an interactive atmosphere and vibe.” The Members’ Lounge was another popular feature debuted in Paris. “It was quite nice to sit and have a coffee. It was a very nice atmosphere and a welcome addition,” Dr Nuijts said. 
It might even boost membership, said Dr Findl, who was pleasantly surprised by its success. As President of the ESCRS in 2018 and 2019, Dr Cochener-Lamard set out to make the ESCRS more interactive, she said. In addition to the lounge and free paper format changes the society has bolstered online and social media offerings to engage younger members. A new two-level grant programme was initiated to provide smaller sums for new researchers and larger awards supporting major projects. Prof Cochener-Lamard looks forward to seeing the ESCRS increasing engagement with developing nations to provide more education and collaboration through international partners. She also hopes the society will continue refining meeting programmes based on experience and member insights. Above all, Prof Cochener-Lamard hopes the ESCRS will continue to foster a vital and supportive community to further advance the field and its goals. “Besides science we are making great relationships with people. Friendship is in there.” Oliver Findl: oliver@findl.at Beatrice Cochener-Lamard:
beatrice.cochener@ophtalmologie-chu29.fr Thomas Kohnen: 
Kohnen@em.uni-frankfurt.de Rudy Nuijts: rudy.nuijts@mumc.nl Soosan Jacob: dr_soosanj@hotmail.com