Dinner with Eye Surgery Associates
Drs Monika Pradhan, Stephen Guest and Hussain Patel

Dinner with Eye Surgery Associates

July 30, 2018 Naomi Meltzer

A cold, miserable, blustery winter day turned into a crisp clear evening with warm hospitality from Eye Surgery Associates, which hosted a continuing education dinner at a beautiful spot on Auckland’s waterfront in June.

Eye Surgery’s principals Drs Hussain Patel and Monika Pradhan, together with Dr Stephen Guest from the Waikato, whose list of current roles and affiliations is almost as long as a lecture itself, presented an original and topical line-up of subjects.

The good, bad and ugly of technology

First up, Dr Guest shared his experience with implantable miniature telescopes, including an interesting over-dinner video of his surgical procedure, and the necessity of a close working relationship with a trained low vision optometrist for both the initial assessment and post-surgical rehabilitation.

The perfect candidate for this treatment is a patient who is highly motivated with realistic expectations, great family support and deep pockets, since there is no funding available in New Zealand for this low vision aid. Dr Guest added, to be really perfect, the patient should have a tiny central macular scar, preferably due to age-related macular degeneration (AMD); residual vision in each eye of between 6/24 and 6/240, but best around 6/60; phakic with a distance prescription of between -6.00 and +4.00; with a deep anterior chamber; intact endothelium; no other apparent ocular disease; and keen to meet the team regularly for the next three to 12 months!

His second presentation focused on the legal use of lasers, debunking some the myths surrounding the use and misuse of various lasers and explaining the difference between lasers used in ophthalmic practice. Lasers are categorised class 1-4, according to power, where class 1 is the weakest. According to the Summary Offences Act 1981, it is an offence to be in possession of a high-powered laser pointer in a public place without reasonable excuse. Presumably guiding a lost aircraft into port is not considered a reasonable excuse and can lead to a $2000 fine or three months pondering about it in jail. It was reassuring to know that one would have to stare at a low-powered laser pointer (as commonly used in presentations) for a very long time, in a virtually catatonic state, to cause significant retinal burn.

Anti-VEGFs: the good news

As a room full of optometrists devoured a delectable dinner, Dr Monika Pradhan brought us up to date with intravitreal treatments, mainly the Eylea anti-VEGF injection and Ozurdex steroid implants. This was very timely as from July this year there will be public funding available for both these treatments, providing certain patient criteria are met.

While Eylea remains an expensive option for those people currently paying for it, if it is more effective than other options, patients can be referred to their local hospital for funded Eylea for 12 months. Funding is then challenged every 12 months to test if it is still necessary. This also applies to patients currently approved for funding for Eylea’s competitor, Lucentis.

Ozurdex* biodegradable intravitreal implants, however, can be fully funded in both the public and private system, with a maximum of three implants per year. One major advantage of Ozurdex, according to Dr Pradhan, is that although it is a potent soluble corticosteroid, it causes fewer problems with increased intra-ocular pressure in responders, and while a spike in IOP may be recorded post-implant, studies have shown these spikes are not lasting or cumulative.

The evening was rounded off by Dr Hussain Patel’s presentation on new developments in the use of optical coherence tomography (OCT) for glaucoma. We were persuaded that OCT can be used not only for retinal nerve fibre layer analysis, but also for ganglion cell analysis. The progression analysis can be very helpful in monitoring changes, long before visual field changes become apparent. OCT can also be used to see into the anterior chamber angle, however, Dr Patel proceeded to dash our hopes by quietly pointing out this does not replace gonioscopy yet. We were cheered up though by the three-dimensional OCT picture of the angle – a bit fuzzy still but there is hope!

OCT angiography, a non-invasive (no dye injection) visualisation of the blood vessels in the retina is good news for patients requiring glaucoma monitoring. This procedure allows viewing of the deeper choroidal plexus in the optic nerve head, peripapillary areas and macular vasculature for monitoring of vascular changes and decreased blood flow index.

I look forward to future educational meetings from this innovative team.

*For more on Ozurdex funding, see www.eyeonoptics.co.nz/articles/archive/pharmac-approves-ozurdex

About the author

After 30 years in general optometry, Naomi Meltzer realised her passion lay in visual rehabilitation and now runs an independent, low vision consultancy, Low Vision Services in Auckland.