5 Questions with Bill Aylward, MD

1.What tips do you have for anterior segment surgeons who also practice retinal surgery?
Cataract is an inevitable consequence of vitrectomy in a phakic eye. In the older age group, a cataract typically begins to develop within 1 year, particularly if gas has also been used, as for example in the treatment of macular hole. Many retinal surgeons are uncomfortable carrying out anterior segment surgery, as it is not their core business, and they refer patients to an anterior segment surgeon when the cataract develops. However, the progression of cataract usually results in a miserable time for the patient, with multiple changes of spectacles as the induced myopia worsens. An advantage of being competent at both anterior segment and retinal surgery is that combined surgery can be considered. This is particularly appropriate if there is already early cataract present prior to vitrectomy.

2.What are the basic retinal techniques that every cataract surgeon should know?
It is essential that cataract surgeons are able to examine the retina and vitreous with a handheld indirect lens at the slit lamp. Diagnosis of a posterior vitreous detachment (PVD) and identification of lattice degeneration are important prior to cataract surgery. This is not because lattice requires treatment, but so that the risk of postoperative retinal detachment can be discussed more accurately with the patient. Although not proven, it is theoretically the case that, if a PVD is present, then the risk of retinal detachment is much less. In a postoperative setting, the diagnosis of an acute PVD and the detection of any retinal breaks are vital. However, retinal breaks in a pseudophakic eye are often small, anterior, and difficult to detect, so if a PVD is diagnosed and there is uncertainty about the peripheral retina, then referral to a retinal specialist should be considered.

Complications of cataract surgery are thankfully rare, but it is important that the cataract surgeon is comfortable with the initial management of any complications that involve the posterior capsule or vitreous. Posteriorly displaced lens fragments should not be retrieved, as this is likely to require vitrectomy. However, the anterior segment should be cleaned up as much as possible. This requires not only removal of any remaining soft lens matter, but also a careful search for and removal of any vitreous anterior to the capsule. The injection of triamcinolone is a useful technique for detection of vitreous, and the cataract surgeon should be very familiar with his or her particular set-up for anterior vitrectomy.

3. In your opinion,what were the advantages to combining the ESCRS and Euretina meetings, and what changes would you suggest for improvement for possible future joint meetings with the ESCRS?
I think delegates found many advantages to the joint meeting, not least of which was the convenience of covering retina and cataract and refractive surgery at one location. Twenty percent of the Euretina delegates had registered for both meetings, indicating that this was an important factor. There were two major joint symposia, one on endophthalmitis and the other on myopia, and the large audience for both of these was a testament to their significance. These symposia focused attention on the interface between our subspecialties. It is almost certain that we will be repeating this style of joint meeting in the future, perhaps with more instructional courses aimed at teaching retinal techniques to anterior segment surgeons and vice versa.

4.What advice would you give to colleagues trying to balance multiple professional activities, such as teaching, publishing, and holding a board position with an ophthalmic society?
There are only 24 hours in a day, so if you find that you have taken on too many commitments (a common problem) the only way to cope is to maximize your efficiency. Modern information technology has given us the means to do this, and a laptop computer is the single most useful device for helping with a workload. Essential qualities include the ability to carry a compact and searchable filing system with you as well as the ability to do useful work during those small intervals throughout the day (eg, between surgical cases, waiting for flights or trains) that are otherwise wasted. Ensure that quality does not suffer in your efforts to juggle tasks. Finally, learn to say no.

5.What have you not yet done that you would like to accomplish in the future?
I would like to see much better use of information technology in ophthalmology, which, like other specialties in medicine, is still largely paper-based. Effective informatics would allow more efficient and safer patient care and ease of research and study of outcomes. I am working on a project that will help toward this goal, so please watch this space.