Toronto Cataract Conference

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

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TORONTO CATARACT CONFERENCE | February 22, 2020

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

What’s new in Ontario Health

QBP Quality Domains

Report Wait Times 1 & 2 Accurately

8:15 AM | EPSO Update

OMA formed the Medical Payment Services Committee (MPSC)

Eye Health Council of Ontario (EHCO)

Private Health Insurance

08:35 AM | Social Media and Ophthalmology

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

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

Who is appropriate? Who decides?

Who is Priority? Patient Decides?

10:00 | A Novel Way to Manage SOB

Continuous High-Flow O2 /// Optiflow

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

Freedom from the microscope eyepieces

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

Accuracy of IOL Calculation Formulas – AAO Journal

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

10:40 AM | Cataract Surgery After Intravitreal Injections

11:15 AM | Let’s Hear From Optometry

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

13:15 PM | Video Session and Discussion

14:15 PM | Overview of Optics and Surgical Approaches

4 Buckets of Vision Choices

Increasing Functional Range of Vision

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

14:35 | Alcon Vivity IOL

**DFT1015 not yet approved by Health Canada

VARMA Standard – MET

*shape similar to IQ lens

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

*Who is a Good Candidate for Monovision?

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

Hx - gradual, progressive, glare

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

(POD1 – sudden vision loss)

15:42 | A Malignant Situation

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

16:03 | Descemet’s Bubbling ff Cataract Sx

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