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Today's Practice | Jul 2011

5 Questions with Daniel Elies, MD

1.What is the current focus of your research?

I am currently involved with three research topics, all of which are linked to different ophthalmic companies. My colleagues and I are developing a customized aspheric lens with Oculentis BV (Eerbeek, Netherlands) that is based on the topographic and corneal aberrometer measurements of the KR-1W Wavefront-Topography System (Topcon Europe Medical BV, Capelle a/d Ijssel, Netherlands). The lens induces a specific spherical aberration in the eye to improve visual depth of focus and compensate for presbyopia induced by pseudophakia after cataract surgery. We are also evaluating the refractive results and quality of vision achieved with femtosecond lenticule extraction (FLEx) and small incision lenticule extraction (SMILE) using the VisuMax Femtosecond Laser (Carl Zeiss Meditec, Jena, Germany). Finally, we are evaluating the reproducibility, safety, overall fluidics, and endothelial cell loss associated with performing cataract surgery through corneal incisions of less than 1 mm with the Stellaris (Bausch + Lomb, Rochester, New York).

2. In what ways do you anticipate refractive surgery will evolve in the future?

The future of refractive surgery is emmetropia as a global concept, meaning the achievement of good vision at all distances without requiring optical correction. To achieve this, we will apply new technologies such as the femtosecond laser to cataract surgery or to lamellar cuts for corneal lenticule insertion. We will use new and better ablation profiles with the excimer laser to control induced aberrations or compensate for existing ones. With the next generation of IOLs, we will improve depth of focus to achieve good quality of vision at all distances and for patients of all ages. New instruments and technologies will improve our diagnoses, and they will help us to identify the best candidates for any procedure (corneal or intraocular refractive surgery). Finally, new optical biometers and ray-tracing formulas will help us to achieve excellence in IOL calculation.

3.What surgical techniques have you recently adopted?

I always try to update my techniques according to evidence presented in studies. For instance, I am implanting IOLs with different asphericity depending on the existing corneal spherical aberration. When I implant intrastromal corneal ring segments, I use the femtosecond laser for channel creation. I am also moving to a smaller corneal incision in cataract surgery, and I am performing surface ablation rather than LASIK in most of my patients when corneal refractive surgery is indicated.

4.What is most challenging about performing live surgery at ophthalmic meetings?

The most important thing to remember during live surgery is to honor the patient’s eye and to consider and respect it as if it were your mother or father’s eye. It is challenging to perform a perfect, standardized surgery and to teach some tricks and pearls to the audience at the same time. It is important to remember that, in live surgery, you are in the operating theater as a teacher, not only as an artist.

5.What are your interests outside of ophthalmology?

As my wife often says, ophthalmology is my first, second, and third hobby. I spend my free time with my family skiing or trekking in mountains or hills. I like to travel to tour natural environments, and sometimes I am able to practice two other sports that I enjoy in these places—hunting and fishing.