Reporting live from WOC2018 in Barcelona, Spain, Monday, June 18, 2018.


The WOC2018 continued on Monday, with programming on a wide variety of topics across ophthalmology.

Refractive surgery seeing a technology revolution
Cutting-edge concepts in refractive surgery, ranging from presbyopia correction to innovations in laser refractive surgery and beyond, were addressed in the Monday morning session “The Upcoming Technology Revolution in Refractive Surgery.”
Guy Kezirian, MD, Scottsdale, Arizona, U.S., first brought up the various sociologic factors related to refractive surgery.
“It’s time for us as a profession to consider the sociology of what we do,” Dr. Kezirian said, adding that there are a broad range of things impacted by refractive surgery, such as psychology, education, lifestyle, fitness, and safety.
From a psychological standpoint, Dr. Kezirian said the profession hasn’t really acknowledged the psychological impact of refractive surgery on adolescents. He discussed the results of a study that found kids who wore glasses, on average, had lower self-esteem, were lonelier, experienced more criticism, had a higher weight, felt more fear, and had stressful events related to being lost without their glasses. For this group, Dr. Kezirian said refractive surgery can offer hope, with glasses and contact lenses being a bridge to get eyes to maturity before they can be fixed with refractive surgery.
There are occupational hazards that result from wearing glasses and contact lenses. In some fields, due to these hazards, Dr. Kezirian said refractive surgery has become a common procedure, but “we haven’t evenly penetrated all fields and it’s time to do that.”
There are also safety implications inherent with glasses and contact lens wear. Glasses can be lost or forgotten, which is dangerous in an emergency situation. Contact lenses require proper care and without it can result in infections and corneal ulcers. There are also issues with glare at night.
Then, there’s the cost/economics related to the lifetime of glasses or contact lens wear, which is more expensive in total when compared with the one-time cost of refractive surgery, Dr. Kezirian highlighted on an illustrative slide.
While there are efforts to provide refractive correction via glasses to those in developing countries, Dr. Kezirian said he thinks refractive surgery should be delivered as primary care on a global scale. Glasses, again, can be lost, broken, and are difficult to deploy in certain areas.
“Much of the world skipped telephone lines and went straight to cell phones. … I think we will skip glasses technology and go straight to refractive surgery having fixed their eyes,” he said.
With the increase in myopia on a global scale as a result of environmental factors, Dr. Kezirian said there is a place for myopia control, through things like schools making an effort to get students outside, campaigns to reduce near screen time, and more.
“Refractive errors can be corrected across the span of a lifetime,” Dr. Kezirian said, adding, however, that less 4% of the world’s population has ever seen refractive surgery. “Right now, vision correction is still back in the early 20th century. We have to bring it forward to the 21st century,” he emphasized later.
In terms of what’s new or coming down the pike in refractive surgery, L. Felipe Vejarano, MD, Popayan, Colombia, presented about pharmacologic presbyopia control, specifically with a drop that he created called FOV Tears. The compound has been tested in a non-controlled prospective study, showing safety and efficacy of improved both far (0.5–1 D) and near (2–3 D) vision, especially with continued use; a controlled study is planned. Dr. Vejarano also provided data about his own personal experience with the drops as well.

Current options in keratoconus treatment
What are the current options for treatment of keratoconus and corneal ectasia? What might be available in the future? How is it detected and diagnosed? How can the cornea be regularized? And what combinations of procedures are there for stopping progression and regularizing the cornea? These questions and more were answered during a Monday morning session hosted by the Barraquer Institute.
Jose Lamarca, MD, Barcelona, Spain, discussed the indications for crosslinking, its contraindications, and the various ways in which the procedure can be performed. There are different agents that can help induce a corneal collagen crosslinking effect, but the most effective, to date, is riboflavin and UV-A exposure. There is also debate on whether the epithelium needs to be removed or not. If the epithelium is left on, there are different modalities being employed and/or evaluated to improve the crosslinking effect, including femtosecond laser-assisted crosslinking, iontophoresis, intracameral injection of riboflavin, and nanoriboflavin.
There are also different applications of treatment, such as central, peripheral, and customized crosslinking. There are also different protocols, including the standard Dresden, accelerated, and continuous vs. pulsed.
Dr. Lamarca emphasized that while much is being done in the way of research to preserve the epithelium and expand indications for crosslinking, “at the end, we will need more research to know how it’s going,” he said.
Rafael Barraquer, MD, PhD, Barcelona, Spain, tackled the topic of intracorneal ring segments (ICRS) and how to choose the best combination for specific cases. ICRS are implants that occupy space, Dr. Barraquer said. They force collagen to “make a detour,” resulting in the collagen increasing tension and creating a change in curvature through a biomechanical/compressive effect.
Local ICRS of 90 degrees have an astigmatism-correction effect, while circular ICRS have a spherical, flattening effect. Coma can be corrected by asymmetrical implantation of one or two ICRS, Dr. Barraquer said.
Some keratoconus cases can be corrected with ICRS, Jose Alfonso Sanchez, MD, Oviedo, Spain, said, focusing his thoughts on morphological classification of the disease. Overall, he said, that classic classification grades in keratoconus are not enough to establish a nomogram for deciding upon treatment, but classification of keratoconus into phenotypes is possible, with correction strategy depending on phenotype.

Video session encourages audience to ‘make the call’
An interactive session on Monday afternoon featured video cases of cataract surgery complications being presented. The videos were paused at specific points, with audience members voting on management decisions. Panels also discussed the cases.
Some of the cases during the session touched on rapid cataract post-vitrectomy, toric IOL and PCR, traumatic cataract and zonular dialysis, rock hard nucleus and fixed pupil, traumatic cataract, and an unhappy multifocal IOL patient.
David Chang, MD, Los Altos, California, U.S., led the session, along with Filomena Ribeiro, MD, PhD, Lisbon, Portugal. A panel of Alan Crandall, MD, Salt Lake City, Utah, U.S., Ehud Assia, MD, Tel-Aviv, Israel, R.D. Ravindran, MD, Pondicherry, India, and David Spalton, MD, London, U.K., weighed in, as did a second panel of Luis Izquierdo Jr., MD, Lima, Peru, Burkhard Dick, MD, Bochum Germany, Lisa Arbisser, MD, Salt Lake City, U.S., and Ahmed El-Massry, MD, PhD, Alexandria, Egypt.
One case Dr. Chang shared was using a high power toric IOL in a patient’s second eye. The patient was a 96-year-old who already had a T5 toric in the right eye and presented with a cataract in the left eye with lots of cylinder. The patient needed a T6.
Dr. Chang noted that in this case he experienced temporal PC rent with subincisional I/A and vitreous coming up in incision.
He asked the audience to weigh in on what vitrectomy plan they would choose for a torn PC with vitreous prolapse. Over a third (35%) said they would use CCI and split infusion.
Dr. Ravindran said he would use split infusion and anterior vitrectomy through the limbus with a new incision (and 24% of the audience agreed with him).
Dr. Spalton also agreed that he would use a new limbal incision and split infusion.
While 29% of the audience voters said they would do pars plana plus a limbal infusion cannula, none of the panelists said they would use a pars plana approach.
However, the pars plana approach was actually how Dr. Chang proceeded in this case. It’s hard to get through the proximal opening, he said, and the goal is to not expand the rent. If you do an anterior limbal approach, you’re going to bring vitreous up and expand the rent, he said, so the pars plana approach can help eliminate this risk.
Dr. Ribeiro said that, though the pars plana approach is not dangerous, she just doesn’t frequently use this approach.
Dr. Chang next questioned the audience about which IOL option they would choose moving forward. Of the respondents, 10% said they would choose a toric SPA IOL in the bag, 25% would choose a toric SPA IOL in the bag with reverse optic capture, 10% would choose a non-toric SPA IOL in the bag, 55% would choose a non-toric 3-piece IOL in the sulcus, and no one in the audience voted to enlarge the incision and use an AC or PC PMMA IOL in the sulcus.
Dr. Crandall said, in this case, since the patient is 96, you don’t want to go back to the OR. He added that alignment could be problematic if you’re trying to reverse optic capture, and he would choose to abandon the original plan and do an LRI or something else. You could consider an anterior chamber lens, he said.
Dr. Chang chose to still proceed with the toric because he already had a toric in the other eye. The worst thing that could happen is dislocation, he said.
During the procedure, Dr. Chang said the haptics unfolded slowly and the case ended looking good. He put Miochol in to bring the pupil down as quickly as possible.
Dr. Chang emphasized that, during the procedure, he was doing everything to not expand the tear, but he also noted that the tear won’t wrap around if you don’t put a lot of pressure on it and pull vitreous up through it.
With the case completed, Dr. Chang asked the audience what they would tell the patient immediately postop. Half (50%) of the respondents indicated that they would discuss the unexpected “difficulty” but not specifics and tell the patient that “everything’s fine.” Meanwhile, 21% of respondents said they wouldn’t mention any complication, unless a problem should arise later, and 29% said they would discuss the PCR but not the lack of the 3-piece MF.
Dr. Ribeiro said that you must tell the patient what happened.
Dr. Chang added that at 1-month postop, the lens was well centered, and he concluded by asking the audience how they would react if the patient had experienced 15 degrees of misalignment and was symptomatic. Most (67%) said they would leave the patient alone and correct with spectacles, while 3% would reposition in the bag, 19% would reposition in the bag and do reverse optic capture, 6% would do an IOL exchange with a 3-piece IOL in the sulcus, and 6% would refer the patient.


EyeWorld Meeting Reporter is a digital publication of the American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Administrators.

Medical editors: Eric Donnenfeld, MD, chief medical editor; Rosa Braga-Mele, MD, cataract editor; Clara Chan, MD, cornea editor; Nathan Radcliffe, MD, glaucoma editor; Vance Thompson, MD, refractive editor

For sponsorship opportunities or membership information, contact:
ASCRS•ASOA • 4000 Legato Rd., Suite 700 • Fairfax, VA 22033 • Phone: 703-591-2220 • Fax: 703-591-0614

Opinions expressed in EyeWorld Meeting Reporter do not necessarily reflect those of ASCRS•ASOA. Mention of products or services does not constitute an endorsement by ASCRS•ASOA.

Copyright 2018, EyeWorld News Service, a division of ASCRSMedia. All rights reserved.



Para nosotros es un orgullo compartir con ustedes que el Dr. Felipe Vejarano estuvo presente en el International Congress of German Ophtalmic Surgeons, que se llevó a cabo en Nuremberg Alemaniael día 15 de Junio del 2018, hablando sobre el manejo farmacológico de la presbicia.




  WOC2018 Barcelona España


Cataract Surgery Olympics  Jun 16 - 19


Seguimos sumando logros y queremos compartirlos con ustedes. El Dr. Felipe Vejarano

presente en el Congreso Mundial de Oftlamología WOC2018 desde el

16 hasta el 19 de Junio, realizado en Barcelona. 



 Simposio Presbicia



Simposio Catarata Hipermadura


                          Oftalmólogo caucano inventa gotas para combatir la presbicia



  • Queremos compartir con ustedes un articulo que nos llena de mucho orgullo publicado por la revista REVIEW Of Optometry el dia 15 de Febrero de 2016 acerca de las gotas para la presbicia PresbV Tears, desarrolladas por el Felipe Vejarano, MD



  • Compartimos el siguiente artículo publicado por la revista Ophthalmology Times cutting edge advancements el dia 1 de Octubre de 2011 acerca del método para lo corrección de presbicia por medio de cirugía láser (Presb-V) desarrollada por el Dr. Felipe Vejarano



  • El Dr. Felipe Vejarano asistira al WOC Congreso Mundial de Oftalmología 2016 del 5 al 9 de Febrero de 2016 con sede en Guadalajara.

Los temas a tratar serán:


ComplicatedPhaco cases – my top 5 pearls; PANELIST


Changingthe cornea forRefraction

Paper: Presb V Tears Non InvasiveSolutionforPresbiopia


Pearls And PitfallsforSelecting and ImplantingRefractiveIOLs; PANELIST



CapitainLatinAmericateam – SubluxatedNigranswhit Small FibroticPupil



  • El Doctor Felipe Vejarano asistirá al American Academy of Ophthalmology RefractiveSurgery 2015 con sede en las Vegas, USA  14 al 17 Noviembre 2015


Los temas a tratar serán:

  • Introduction of TroutmanPrize J. Bradley Randleman MD
  • TroutmanPrize: AntibacterialEfficacy of AcceleratedPhotoactivatedChromophoreforKeratitis-Corneal CollagenCrosslinking Olivier Richoz, MD
  • The Role of PTA in ScreeningMarconyR Santhiago, MD
  • SimultaneousCorrection of Unilateral RainbowGlare and Residual AstigmatismbyUndersurfaceFlapPhotoablationAfterFemtosecond Laser-AssistedLASIK DamienGatinel MD
  • Stromal Surface Topography-GuidedCustomAblation as a RepairToolfor Corneal Irregular Astigmatism Dan Z Reinstein MD
  •  Long-TermPostoperativeResults of T-FixationTechniqueUsedforIntrascleral Posterior Chamber Intraocular Lens FixationToshihikoOhta, MD
  • Profocal Cornea CreatedbyTransparentHydrogel Corneal Inlay: Mechanism of Action and ClinicalImplications Douglas D Koch MD
  • InitialClinicalExperiencewith a New Laser Approachfor Precise Capsulotomies  Richard B Packard MD
  • Micro-Electrostimulation of theCiliaryBody as a New Non-InvasiveMethodforPresbyopiaTreatment: EarlyResults Luca Gualdi, MD
  • SedkyApproachforRelExSmile Re- Treatment Ahmed N Sedky, FRCOPHTH
  • DiagnosticIntraoperative and SweptSourcePostoperativeOpticalCoherenceTomography (OCT) forthePrediction of Postoperative Intraocular Lens Position DuringFemtosecondRefractive Laser AssistedCataractSurgery (ReLACS) Joseph J Ma MD
  • RefractiveLenticuleImplantation (Relimp) for Unilateral Aphakia Osama I Ibrahim MD PhD
  • PRESBV (Presbyopia Vejarano) TEARS Non-invasiveSolutionforPresbyopiaLuis Felipe Vejarano MD
  • JRS QwikFacts J. Bradley RandlemanMD




  • El Doctor Felipe Vejarano asistirá al simposio anual ASCRS en San Diego, California del 17 al 21 de Abril, de 2015.


Los temas a tratar serán:

  • Solución no invasiva para la presbicia Usando formulación oftálmica (Conferencista), el día 19 de abril.
  • Video – Curso Casos especiales y curiosos en cirugía de Catarata (Instructor), el día 19 de abril.
  • ASCRS Sesión de Trabajos Libres 2M "Presbicia Lentes Intracorneales" (Panelista), el día 19 de abril.
  • Multifocal presbicia Tratamiento corneal con el Presbv LASIK (Método Vejarano) (Conferencista), el día 19 de abril.
  • Femto-LASIK Versus SBK-LASIK con microqueratomo mecánico (Conferencista), el día 19 de abril.
  • Facoemulsificación Biaxial libre de Aberraciones y de Inducción de Astigmatismo (Conferencista), el día 21 de abril.