Ophthalmology loses Roger F. Steinert, MD

The much-honored innovator and teacher passed away June 6.

By René Luthe, senior editor

Ophthalmic giant Roger F. Steinert, MD, died on June 6, following a 2.5-year battle with glioblastoma. He was 66 years old. A pioneer in laser surgery techniques and an innovator in corneal transplantation techniques, Dr. Steinert developed ophthalmic applications of the Nd:YAG laser, the excimer laser and the femtosecond laser. In fact, he was among the first group of surgeons to conduct FDA trials of phototherapeutic and photorefractive keratectomy in the 1980s, and he presented studies to the FDA’s ophthalmic devices panel when it was considering the new technologies for approval. Also in the course of his remarkably fruitful career, he authored eight books, 116 book chapters and more than 120 peer-reviewed articles, presented 21 named lectures, held 18 visiting fellowships and filed 15 patents.

After medical school at Harvard (where he would later serve on the faculty) and a residency at Massachusetts Eye and Ear Infirmary, Dr. Steinert was a surgeon and corneal fellowship preceptor at New England Eye Center of Tufts University School of Medicine. In 2004, he joined the University of California at Irvine (UCI) as vice chair of the Department of Ophthalmology and professor of biomedical engineering, becoming chair four years later.

While such a position would be considered a prestigious capstone for most careers, Dr. Steinert wasn’t finished yet. Capitalizing on the uniquely high concentration of the ophthalmic industry in UCI’s Orange County, Calif. locale, combined with the university’s resources, Dr. Steinert spearheaded the founding of the Gavin Herbert Eye Institute in 2014. He raised funds for the project and recruited faculty.

Ophthalmology rewarded his contributions with its most prestigious honors. Among them: The International Society of Refractive Surgeons gave Dr. Steinert its Jose Barraquer award in 2008 and its Presidential Recognition award in 2012; the AAO gave him its Lifetime Achievement award in 2009; and the Cornea Society presented him with the Dohlman Award for Teaching Excellence in 2015. He appeared on the Best Doctors in America (Ophthalmology) lists from 1994 to 2013.

And Dr. Steinert won the affection of his colleagues. Says Marjan Farid, MD, one of his recruits to the Gavin Herbert Eye Institute and now director of the Cornea Fellowship program and associate professor of ophthalmology there, “Roger Steinert will be sorely missed. He was a true giant whose work and research transformed what we now take for granted in the field of refractive and corneal surgery. Roger had a generosity of spirit that was unmatched. He shared his knowledge and took great pride in the training of residents and fellows. He uplifted all those who came into his circle. We are all better doctors, surgeons, educators and humans because of his influence in our lives.”

Paul Koch, MD, Ophthalmology Management’s editor emeritus, prefers his memories of Dr. Steinert outside the clinic: “Roger was appreciated for his clinical acumen and inquisitive nature, but I would not want this moment to pass without acknowledging his sense of humor. Whether it was a clever turn of a phrase, a humorous film or a bawdy joke, Roger was always ready to contribute to the merriment. I choose to remember sitting with Roger and April (his wife) at an outdoor cafe laughing the afternoon away.” OM

David Karcher to retire as leader of ASCRS next year

Karcher served as CEO and executive director since 1981.

By Robert Stoneback, associate editor

Effective at the end of 2018, David Karcher will retire from his role as CEO and executive director of the ASCRS. He has served in both of these roles since August 1981. Mr. Karcher will continue to act as a consultant to ASCRS through 2021. He announced his retirement plans via press release in June.

A search committee, chaired by Eric D. Donnenfeld, MD, has been formed to begin finding a replacement for Mr. Karcher.

The executive search firm Leonard Pfeiffer & Company, based in Washington, DC, also will assist in the search.

“HEART AND SOUL”

“David Karcher has been the heart and soul of ASCRS for 30 years,” says Dr. Donnenfeld. “Without David Karcher, ASCRS is an entirely different organization. David has made ASCRS a meritocracy where hard work and good ideas are reward and our organization continues to advance.”

According to the ASCRS, the organization grew to more than 8,500 members under Mr. Karcher’s leadership; his tenure also saw the organization expand from three employees to 65, and the annual budget grow from $360,000 to more than $23 million.

INTERVIEWS BEGIN THIS FALL

The search committee will begin interviewing candidates in the fall, and plans to select a new executive director in the spring of 2018, says Dr. Donnenfeld.

“We were originally planning to clone David Karcher, but this has not been feasible,” he joked. “Instead, we will be looking for a great leader with a skill set to lead ophthalmology into the next generation.”

Inquiries regarding the search committee should be sent to Zara Sulayman, zrsulayman@pfeiffercompany.com, 202-737-6327 x 24. OM

Bausch + Lomb “accelerates growth” with new technologies

This year, the Stellaris Elite, Vitesse, FortifEye and Osher No Fly hit surgery centers.

By Robert Stoneback, associate editor

Bausch + Lomb is back.

The company attended ASCRS this year with four new technologies and several additional pending approval, all of which were created internally at Bausch + Lomb.

“We’re ready to accelerate our growth with these additions,” said Chuck Hess, VP and general manager of U.S. Surgical for Bausch + Lomb, when interviewed at ASCRS in May.

On the show floor, Bausch + Lomb let surgeons “test drive” its Stellaris Elite vision Enhancement system in interactive wet lab sessions.

MORE CONTROL, LESS ENERGY

Bausch + Lomb’s goal with the Stellaris Elite vision enhancement system is to give physicians more control, says Mr. Hess. Two of the key features of the Stellaris are Adaptive Fluidics, which gives precise aspiration control, and the Attune energy management system, which can result in a reduction in energy use, says Mr. Hess.

The Stellaris Elite received FDA clearance in April and is now available to surgeons.

Prior to ASCRS, 20 surgeons performed 400 procedures using the Stellaris, according to Mr. Hess.

Different upgrades and enhancements will be available to expand capabilities of the Stellaris; one of the first, the Vitesse open port vitrectomy system, received FDA clearance in April. The Vitesse is the company’s new hypersonic vitrectomy technology; unlike the current technology, it uses a “guillotine-style” vitrectomy cutter, liquefies the vitreous and then aspirates it.

Bausch + Lomb received feedback from numerous physicians when designing the Vitesse technology.

THE OSHER “NO FLY” AND FORTIFEYE

Other new Bausch + Lomb products shown at ASCRS were the FortifEye capsular tension ring, expected to launch this summer, and its new line of Storz ophthalmic instruments. Part of this line is the new Osher “No Fly” cataract instrument set, designed with the help of Robert Osher, MD, professor of ophthalmology at the College of Medicine of the University of Cincinnati and medical director emeritus of the Cincinnati Eye Institute. The “No Fly” set was designed to work specifically with overhead devices, to minimize the risk of instruments hitting attachments that fall below the scope, such as aberrometers. OM

Depression linked to vision loss

One in five newly vision-impaired patients showed signs of depression.

By Robert Stoneback, associate editor

Data presented at ARVO indicates a link between vision loss and depression. After monitoring 367 adult patients whose vision was newly impaired at ophthalmic clinics across several specialties, researchers from Wills Eye Hospital found that 18% of patients at general ophthalmology clinics had depression. This also was found in 20% of patients at cornea clinics, 22% at glaucoma clinics and 20% at retina clinics. The research was presented as a poster at the recent ARVO conference in Baltimore.

The researchers, including Julia A. Haller, MD, Wills’ ophthalmologist-in-chief, recommend that their peers monitor patients for psychological risk factors.

POOR VISION, SMOKING, DIABETES

Health factors associated with depression in the study were low vision, blindness, smoking status and diabetes. Of the study participants, 21% were current smokers, 20.7% had diabetes and 11.4% had low vision or blindness.

Depressive symptoms were assessed using the PHQ-9 depression questionnaire. According to the study, any patient “who reported suicidal ideation” was referred to psychological services.

It is important to let patients know that they may benefit from talking to a counselor, such as a psychologist or psychiatrist, to discuss how they are coping with vision changes, according to Dr. Haller, chair, department of Ophthalmology, Sidney Kimmel Medical College, and Lisa A. Hark, PhD, RD, director, Glaucoma Research Center at Wills, in a joint e-mail. Often, vision changes will worsen over time without appropriate treatment and follow-up eye care, they wrote.

SIGNS OF DEPRESSION

Noticeable signs of depression include a patient withdrawing from everyday activities and lacking motivation to engage with family and friends. Declining vision may result in other health problems, such as injuries from falls or accidents. A socially isolated patient is also more vulnerable in terms of his well-being, according to Dr. Hark and Dr. Haller.

Depression can also have a more direct impact on health, such as making a diabetic patient more resistant to insulin, they say.

STARTING A CONVERSATION

An easy way to start talking about depression with a patient is to ask how she is feeling, say Dr. Haller and Dr. Hark. If she answers not well, the doctor can follow by asking about changes in mood, appetite or sleep patterns, which can be signs of depression.

One suggestion they have is for ophthalmologists to meet with local mental health-care professionals to serve as potential referrals for patients who need additional support, “just as they identify, for example, endocrinologists for diabetic referral needs.”

Because depression affects quality of life, it “in turn can affect motivation to get an eye exam and to take eye medications, despite the fact that both of these can prevent blindness,” say the researchers. “We hope more ophthalmologists will raise their awareness level, ask their patients how they are feeling and refer those with suspected depression or at higher risk for depression for counseling or treatment.” OM

Seeing the world through eSight

The electronic glasses use cameras and high-quality displays to let the legally blind actually see.

By Robert Stoneback, associate editor

Electronic glasses designed to help the visually impaired see have become so popular that the manufacturer is having trouble keeping its latest model stocked.

The eSight headset has been available for more than three years, but now “we can’t keep up with the demand,” says Brian Mech, president and CEO of eSight Corporation, and holder of a PhD in materials science. The eSight is registered with the FDA and Health Canada, and available in both countries; a European launch is “imminent,” says Dr. Mech. eSight received its CE mark for the European market this June.

THE ESIGHT 3

The eSight is a wearable electronic device that fits over a patient’s eyes and allows the legally blind to see using a high-speed camera mounted on the front of the glasses. The camera transmits images to a pair of OLED screens on the visor interior, which are placed in front of the viewer’s eyes.

The average correction for eSight is 20/25 vision, says Dr. Mech. The eSight cannot help people who are completely blind, but can help people with vision ranging from 20/70 to about 20/600; some have been in the 20/2500 range.

The eSight, which can be worn over glasses, assists with more than 50 vision-based impairments, says Dr. Mech, the full list of which is on the company’s website. The success rate for the eSight is about 80%, he adds.

Since 2013, eSight has introduced three models; the latest model was reduced in price from $15,000 to $9,995, to make the glasses more accessible to as many individuals as possible, according to Dr. Mech. A fundraising program is available through eSight to help patients afford the pair of eGlasses.

Insurers and Medicare don’t yet cover eSight; Dr. Mech calls that a longer-term effort, but “one we’re set to undertake.”

BETTER THAN “STAR TREK”

Jeff Regan started using the eSight about four years ago. Mr. Regan, who lives in the Canadian city of London, was born with optic nerve hypoplasia, or an incomplete optic nerve.

“I had glasses by the time I was eight months old,” he says, with vision that was like “a low-resolution picture.” As he grew older, he became presbyopic and had to carry several glasses and magnifiers.

He had trouble seeing anything clearly unless it was about an inch away from his face, which made his hobby of designing circuit boards much harder. Since he started using eSight three and a half years ago, “there’s no more climbing on the workbench to read the labels on the 600 or so parts drawers.”

He even got a chance to show the eSight to actor LeVar Burton, whose character on the show “Star Trek: The Next Generation” used a futuristic visor to overcome his blindness. They met when Mr. Burton was a guest at a comic convention in Mr. Regan’s hometown.

Scott Reese, of Indianapolis, saw his first Colts football game thanks to eSight. Mr. Reese, like Mr. Regan, was born with optic nerve hypoplasia, but his sight trouble didn’t stop him from growing up to be a big sports fan. Now, he can see the game instead of just hearing it. “These glasses are allowing me to enjoy games much more than I did before.”

After he got his eSight visor, the compan got him a VIP pass to an Indianapolis Colts game this New Year’s Day. What the Colts didn’t tell him, until he arrived, was that he would also walk onto the field to present the game ball.

Mr. Reese is now raising money, through eSight, to help others afford the electronic glasses. “I want other people to have the same opportunity,” he says. OM