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Today's Practice | Jun 2011

5 Questions with Vikentia Katsanevaki, MD, PhD

1.What attracted you to the field of ophthalmology and, more specifically, refractive surgery?

When I was a medical student at the University of Crete, I would never have expected that I would become an ophthalmologist. I was attracted to major surgical specialties, and I thought that I would become an abdominal surgeon. After I graduated, I pursued postdoctoral work because I wanted an academic career. In the early 1990s, Ioannis G. Pallikaris, MD, PhD, of the Institute of Vision and Optics, Heraklion, Greece, was already known worldwide for the development of LASIK. After I graduated in 1994, I was awarded a scholarship as a postgraduate researcher for Dr. Pallikaris. I completed my PhD on phototherapeutic keratectomy even before I finished my residency. Soon, I felt that a career in ophthalmology was what I would like.

At that time, we were correcting -20.00 D of myopia with the excimer laser on the corneal level. Microkeratomes could often be hazardous, and we knew little about the optics of corrected eyes. Based on the current standards, we had terrible complications, yet more and more people sought refractive corrections. Since then, refractive surgery has evolved rapidly. Generations of excimer lasers improved within a couple of years, active eye trackers became the standard, and wavefront technology set the clinical platform to detect and better understand human optics. Nomograms, ablation limits, and ablation profiles evolved to bring photorefractive corrections to the current state of art. The terrible complications of the early generation of microkeratomes and inadvertent corneal healing response due to energy delivery mistakes are now of only historical value. I was lucky to witness this evolution since its early days, and I have been amazed by the fast changes in the field. Retrospectively, I think I could not have made a better choice.

2. How has refractive surgery changed since you began practicing?

As I mentioned above, refractive surgery is not what it used to be. In the early days, not only were we using primitive lasers and surgical tools, but our technology was limited for investigating eyes surgically in the clinical setting.

Before the advent of active eye trackers, patients were often left with eccentric ablations and resulting poor optics, we barely knew the risks for ectasia, and we were using microkeratomes that cut flaps of unacceptable size and thickness according to the current standards. Some of these patients sought retreatments. Even those patients who did relatively well after the primary surgery have experienced significant regressions over the past 10 to 15 years or have been referred for cataract surgery. As technology now allows me to practice refractive surgery routinely, retreating those cases with success remains the most challenging part of my refractive practice today.

3.What do you feel are some of the most promising developments in refractive surgery?

Presbyopia remains the last frontier of refractive surgery. It became obvious that early attempts at scleral expansion were not the way to go. Among the current treatment modalities for presbyopia—various ablation profiles with the excimer laser, other forms of energy delivery to the cornea, IOLs, or corneal implants—none address the problem per se, which is the loss of elasticity of the natural crystalline lens. As excimer lasers have evolved to their peak, offering us the most of what these lasers can do, the recent advent of the femtosecond laser for phacoemulsification is probably the most important innovation in refractive surgery in recent years. The femtosecond laser is not only leading cataract surgery to different levels of safety and reproducibility—thus truly introducing phacoemulsification as a genuine refractive procedure—but it also sets the stage for a new modality to interact with the crystalline lens. Why should we not anticipate answers for treating presbyopia in the future through this modality?

4.What important points of advice can you offer regarding how to be an effective presenter at clinical meetings?

Being an effective presenter combines different demands. There is no doubt that mastering the topic is the mainstay of a successful presentation. How many times have we attended boring lectures given by otherwise experienced researchers or clinicians? A successful presentation should address two main questions: (1) what does the presenter mean, and (2) how does he or she know this information? These two answers must be made clear through a wise use of limited time. The purpose must be specific. The method, the pertinence of the results, and the conclusion should also be short and clear. Busy slides are never welcome by an audience already bombarded with information. Slides must be easily understood with short messages and comprehendable charts. Videos and images are also welcome. The slide count should be limited to the smallest number possible. Finally, especially for international presenters whose native language is other than English, it is a good idea to speak slowly to compensate for an accent that the audience may have difficulty following. Presenting scientific work is a skill that is developed much like surgery: The more you do, the better you get.

5. Describe your ideal vacation destination.

Ophthalmology gave me not only the joy of treating patients and making a living out of the practice, but also the opportunity to travel around the world for refractive surgery meetings. I have visited magnificent sites carefully chosen by the locals so that I get to see the best of all these locales. There are still countless places I plan to visit over the next several years. However, when it comes to my summer vacation, Greece and its numerous islands remain at the top of my list. For those who have not experienced the Greek islands, I suggest that you charter a boat and explore the islands in the summer. I am sure that you will have an unforgettable vacation.