TORONTO CATARACT CONFERENCE | February 22, 2020

Main Program

8:00 AM | Cataract Surgery – State of the Union

Dr. Sherif El-Defrawy

What’s new in Ontario Health

CCO, Health Quality Ontario, eHealth Ontario,
Five Interim and Transitional Geographic Regions

QBP Quality Domains

- Effectiveness and Safety
- Appropriateness
- Access – TARGET 182 days (6 months)
- Efficacy
- Integration

GOOD – STATE
- Performing effective surgery w/ high patient satisfaction

Report Wait Times 1 & 2 Accurately

Support EPSO

8:15 AM | EPSO Update

Dr. Baseer Khan (covering Dr. Raj Rathee)

OMA formed the Medical Payment Services Committee (MPSC)

Current Stats:
No fee code reductions
Increase in IHF and office-based tech fees

Eye Health Council of Ontario (EHCO)

8:25 AM | Public and Private Cataract Surgery in Australia: What Can We Learn?
Dr. Tanya Trinh

Private Health Insurance

- Choose your specialist
- Guaranteed right to renew
- Not tied to employment
Wait Period x Cataract Surgery in Australia (medicare – 6-18 months; private – will depend on
dr’s availability; pay upfront – will also be depend on dr’s availability)

08:35 AM | Social Media and Ophthalmology

Dr. Valentina Lozano

08:45 AM | Keynote: Learning New Techniques After Residency

Dr. Tom Oetting (FB – cataract.surgery)

1. Build Skills
2. Slow Transition in OR
3. One new thing at a time

09:10 AM | Cataract Surgery Appropriateness, Prioritization and Outcomes, What Should We

Do?
Dr. Matt Schlenker

Who is appropriate? Who decides?

Doctor – has to feel comfortable; clinical acumen/experience
Patient – patient centered; day to day concern

Who is Priority? Patient Decides?

10:00 | A Novel Way to Manage SOB

Dr. David Lane

Continuous High-Flow O2 /// Optiflow

= Pneumonia
= ICU Bridge

Ophthalmology?
COPD, Pulmonary Fibrosis, Heart Failure (higher flow rates, individual basis), decrease

Optiflow
- Warm, moist (comfortable)
- High flow O2 (60 l/min)

10:10 AM | Heads Up 3D Surgery: Why This is the Future

Dr. Kathy Cao

Freedom from the microscope eyepieces

“Heads Up” position
Passive 3D System
Available: Alcon Ingenuity, Zeiss Artevo 800, Leica w/ Truevision

Benefits
Patients – comparable to conventional binocular microcope sx; Vitreoretinal sx (reduction in
endoillumination – less photo toxicity)
Surgeons – high demand specialty; similar to professional athletes; ergonomics; increased
depth of focus, integration (soon) simultaneous display of preop exam, phaco and microscope
settings, toric axis
Learners – teaching and telemedicine, small and large group audiences, review video cases
OR Team – everyone has the same view, more engagement, helps w/ flow (allow for better
participation of the surgeon’s need for additional instrumentation, extra sedation, etc.)

10:20 AM | Biometry Update in 2020: The Latest

Dr. Amandeep Rai

(Formulas) Barrett Universal; ASCRS Post LASIK; Barrett True K; Kane; Olsen; EVO; Hill RBF;
Haigis; Holladay 1; Holladay 2; SRK/T; Hoffer Q

Accuracy of IOL Calculation Formulas – AAO Journal

10:30 AM | EMBD: Should I Do A Superficial Keratectomy before Cataract/IOL Sx?

Dr. Trina Trinh

EMBD
- Bilateral asymmetric “dystrophy”
- Female > Male
- 40s-50s
- “Map-Dot Fingerprint”

Symptoms
Sudden fluctuations in vision, multiple glasses adjustments, pain (night, lid stuck to eyeball),
ghosting/diplopia, family hx/trauma or recurrent episodes

Look
Slit-Lamp – lift upper lid – check sensation
Retro-illuminate w/ dilated pupil in background

Evaluate data

Superficial Keratectomy

10:40 AM | Cataract Surgery After Intravitreal Injections

Dr. Tom Oetting
 - Groove then Divide then Hydrodelination
- V Technique

11:15 AM | Let’s Hear From Optometry

Dr. Anu Ondhia

Top 5
1. The patient on the table is BOTH yours and the OD’s.
2. An OD can spend the time to review the px’s entire visual system
3. Efficiency
4. The pre and post-op cycle – building a wealth of experience shapes future referrals
5. Why not?

11:25 AM | Delegating/Co-Managing Postop IOL Care with Optometry

Dr. Devesh Varma

13:15 PM | Video Session and Discussion

Dr. Tom Oetting

14:15 PM | Overview of Optics and Surgical Approaches

Dr. Ike Ahmed

4 Buckets of Vision Choices

1. Distance (or near intermediate) ou
2. Multifocal IOL
3. EDoF IOL (diffractive vs non-diffractive designs)
4. Monovision (full, mini, micro)

Increasing Functional Range of Vision

 Monovision: Full, mini, micro
 Spherical aberration induction
 Wavefront shaping
 Accommodating IOL
 MFIOL
 EDOF IOL

Trifocal IOL

EDoF – Quality of Vision; Different (?reduced) halos and glare

Trifocal – Full Range of Vision

14:35 | Alcon Vivity IOL

Dr. Devesh Sharma

**DFT1015 not yet approved by Health Canada

EDOF IOL
ANSI Standard – MET
- Defocus 0.5D more than monofocal at 0.2 logMAR
- DCIVA (superior to monofocal/0.2 logMAR or better in 50% of eyes)
- BCDVA – monofocal

VARMA Standard – MET

- Continuous focus from distance to arm’s length (1.5D defocus)
- Minimal halo/glare/starbust
- Good contrast

*shape similar to IQ lens

**difference – there’s like a donut-shape in the middle (1 micron elevated – changes focus pt)

14:45 | Hey! What About Good Old Fashion (mini) Monovision?

Dr. Steve Arshinoff

*Who is a Good Candidate for Monovision?

15:20 | When Cataract Surgery Doesn’t Fix the Problem

Dr. Jonathan Micieli

Hx - gradual, progressive, glare

Phys Ex – cataract, no other ocular explanation

15:30 | Acute Loss of Vision Same Day After Sx

Dr. Amrit Rai

(POD1 – sudden vision loss)

Central Retinal Artery Occlusion
- Thrombolytic Therapy

15:35 | How To DO an IOL Exchange into the Bag after Laser Capsulotomy
Dr. Ike Ahmed

15:42 | A Malignant Situation

Dr. Jeb Ong

Malignant Glaucoma
15:49 | Iris Mishap
Dr. David Yan

15:56 | Phaco in Post-RK (Radial Keratotomy) Eyes

Dr. Clara Chan

16:03 | Descemet’s Bubbling ff Cataract Sx

Dr. Gisella Santaella