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Up Front | Sep 2007

5 Questions With Roberto Bellucci, MD

Dr. Bellucci is Chief of the Ophthalmic Unit at the Hospital and University of Verona, in Italy.

1. Can you please explain how you became involved in ophthalmology?
Ophthalmology was my first love. Early in my medical career, I became involved in ophthalmic care and, consequently, began performing cataract surgery at a small hospital near Verona, Italy. Several surgeries turned into several thousand over the next few years, before I moved on to work at the University of Verona. Eventually, I came into my current position.

Since my journey began, ophthalmic technologies and techniques have evolved and become more refined. I am amazed when I look back at the beginning of my career and realize I was performing intracapsular cataract extraction. Since then, we moved to extracapsular surgery, and finally, phacoemulsification.

I am excited to see what the future holds for this field.

2. What is the focus of your current research?
Presently, my main interest is IOL design. I began studying aspheric IOLs in 2001, and since 2003, I have been measuring the aberrations of these lenses. This work has resulted in three published papers as well as an ongoing study on new aspheric lenses. Last year, I had the opportunity to use the Ophthalmic Quality Assessment System. This Spanish-built machine measures pseudophakic, pre-, and postoperative optical quality.

My colleagues and I are also working with Bausch & Lomb (Rochester, New York) on microcoaxial surgery through a 2-mm incision, and we are investigators for international studies on anterior chamber foldable IOLs.

3. What is your opinion on coaxial and bimanual microincisional cataract surgery?
I think that microincisional cataract surgery (MICS) could be the bridge between standard 3-mm surgery and the bimanual technique. This is not to say, however, that MICS will be a transition modality toward bimanual. Instead, I believe that it will stand alone as a unique cataract surgery, and surgeons who develop this type of MICS will not perform bimanual surgery.

Coaxial MICS has an advantage over bimanual, because it allows the surgeons to use his/her expertise and experience in phacoemulsification, while creating an incision of 2 mm or less. This incision size is here to stay, because it is more respectful of corneal anatomy. For these reasons, coaxial phaco is probably the best way to approach MICS.

4. What do you see as the greatest future advance in cataract surgery?
As far as cataract removal, small incisions will serve as a new modality. We will take further advantage of this technique, especially as new instruments and machines are developed.

Over the next 5 years, I believe we will see thinner IOL models that offer the same optical and clinical properties as their current counterparts, but that are inserted through smaller incisions. Future lenses will also implement asphericity onto the anterior and posterior surfaces as well as the cornea. Additionally, the optical clarity of lens material and the amount of accommodation that they provide will continue to improve.

We are currently researching ways to restore accommodation with a material that reconstructs the anatomy of the human lens. The practical technology is very far off, but its invention would be a dream come true for many ophthalmologists.

5. What is the greatest medical challenge in your field?
In every aspect of ophthalmic surgery, we are now faced with the challenge of meeting an increased patient demand for good refractive results. In the past, ophthalmologists did not address the refractive aspects during so-called necessary vision procedures (eg, hard cataract, retinal detachment).

We have entered an era where patients are looking for both good anatomical and refractive results. Because of this demand, I think that surgeons will have to choose procedures that offer patients better refractive results while addressing their other vision problems. Additionally, as we continue to improve refractive and cataract procedures, we must also offer the patient optical comfort.

In my opinion, there is still a lot of work to be done in studying and achieving better optical results to meet patient demands.