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Interview: Eric Donnenfeld, MD

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Refractive surgery pioneer and CEwire2016 speaker Eric Donnenfeld, MD speaks to us about the importance of preparing the ocular surface before surgery, and future developments coming down the pike.

We also talk about education in eye care, and the future of CE online.

If you haven't yet registered, there's still time to take the courses at CEwire2016 -- now through May 1st!
 
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AdminWolf said:


Refractive surgery pioneer and CEwire2016 speaker Eric Donnenfeld, MD speaks to us about the importance of preparing the ocular surface before surgery, and future developments coming down the pike.

We also talk about education in eye care, and the future of CE online.

If you haven't yet registered, there's still time to take the courses at CEwire2016 -- now through May 1st!
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I just spent 15 minutes listening. Definitely worth your while to learn about the newest developments in cararact and laser surgery.
 
I hope you've been able to take Dr. Donnenfeld's course as well -- it was quite good. He's serious about teaching.
 
AdminWolf said:
I hope you've been able to take Dr. Donnenfeld's course as well -- it was quite good. He's serious about teaching.
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I plan on viewing most of the vids on Wednesday lunch and learns with my interns.
 
Greg Gemoules said:
Mine is the kind of practice where the schools tell their students to stay away from.
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And now back to topic.

do you think based on Dr Donnenfeld's futuristic prognostication there is new dramatic changes that should be part of OD planning for the future?
 
Paul Farkas said:
do you think based on Dr Donnenfeld's futuristic prognostication there is new dramatic changes that should be part of OD planning for the future?
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Dunno. My cataract OMD is currently using techniques discussed by Donnenfeld, and my Cornea guy is a leader for the CXL-USA site. Not sure how we can incorporate that except in our co-management with them.
 
Joe DiGiorgio O.D. said:
Dunno. My cataract OMD is currently using techniques discussed by Donnenfeld, and my Cornea guy is a leader for the CXL-USA site. Not sure how we can incorporate that except in our co-management with them.
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if I were in the contact lens specialty area I would look to the new ophthalmic surgery technology to resolve some of the problems that now require very specialized contact lenses to compensate for corneal distortion.
 
Paul Farkas said:
if I were in the contact lens specialty area I would look to the new ophthalmic surgery technology to resolve some of the problems that now require very specialized contact lenses to compensate for corneal distortion.
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For sure. While I do not have a zillion patients needing these services, we try to refer young cones for CXL consults.

Some patients with poor unstable epithelia are evaluated for PTK

Cataract surgery is now with the latest technology, and several get LRIs or toric IOLs.
 
Paul Farkas said:
if I were in the contact lens specialty area I would look to the new ophthalmic surgery technology to resolve some of the problems that now require very specialized contact lenses to compensate for corneal distortion.
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That seems like a rather weird position for someone who made their fortune fitting contact lenses, and the last thing I would expect you to say. There are a whole bunch of practitioners meeting in Las Vegas this weekend who would not be happy with your assessment. A few of my patients from this week would also disagree with you as they have already been burned by surgery.

The problems with surgery are (in)consistency and (no)recovery from error. The biomechanics of the cornea are different than a piece of plastic. In my opinion we should try harder to make contact lenses better.
 
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Good point Greg. We have several very unhappy R-K patients, from the era of "slash for cash". They should have stuck to their glasses or CLs.
 
Joe DiGiorgio O.D. said:
Good point Greg. We have several very unhappy R-K patients, from the era of "slash for cash". They should have stuck to their glasses or CLs.
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I also have a lot of unhappy LASIK patients. One here this week has LASIK induced ectasia and got crosslinking. He went to every notable lens fitter in the UK and could not get the severe halos and ghosted vision resolved. Today he is 20/15 in each eye with aberrations that are better than the normal population using advanced wavefront-guided lenses. He would not want his corneas shaved again.
 
Greg Gemoules said:
That seems like a rather weird position for someone who made their fortune fitting contact lenses, and the last thing I would expect you to say. There are a whole bunch of practitioners meeting in Las Vegas this weekend who would not be happy with your assessment. A few of my patients from this week would also disagree with you as they have already been burned by surgery.

The problems with surgery are (in)consistency and (no)recovery from error. The biomechanics of the cornea are different than a piece of plastic. In my opinion we should try harder to make contact lenses better.
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My only point is listen to what one of the worlds for most corneal surgeons has to say.

Accept or reject his prognostications.

my limited success in contact lenses was due to being first in embracing new products. Equally important was to move on.

When aphakic contact lenses became obsolete because of aphakic implants they were phased out. When hydrogel lenses became the comfortable alternative to rigid lenses they were embraced and some patients refit. That did not mean all RGP patients were refit. We even had PMMA lens patients who insisted on remaining with their old fashioned contact lenses.

We saw the value of of daily disposable lenses and made certain we did he Phase 3 FDA study and subsequent focus groups to assist Vistakon. Understanding new technology and embracing what you think will work is key to remain current.

When lasik surgery became popular our practice gave second opinions on safety and effectiveness as well as had a close working relationship with TLC. We kept our patients for follow up care rather than discourage them if they wished refractive surgery. We made certain they went to the very best corneal surgeons.

There will be improvements in surgical techniques to make corneal refractive surgery even more safe and effective. It is the responsibility of every contact lens practitioner to understand what is now and future developments rather than be"unhappy with my assessment".

Don't shoot the messenger!
 
Paul Farkas said:
My only point is listen to what one of the worlds for most corneal surgeons has to say.

Accept or reject his prognostications.

my limited success in contact lenses was due to being first in embracing new products. Equally important was to move on.

When aphakic contact lenses became obsolete because of aphakic implants they were phased out. When hydrogel lenses became the comfortable alternative to rigid lenses they were embraced and some patients refit. That did not mean all RGP patients were refit. We even had PMMA lens patients who insisted on remaining with their old fashioned contact lenses.

We saw the value of of daily disposable lenses and made certain we did he Phase 3 FDA study and subsequent focus groups to assist Vistakon. Understanding new technology and embracing what you think will work is key to remain current.

When lasik surgery became popular our practice gave second opinions on safety and effectiveness as well as had a close working relationship with TLC. We kept our patients for follow up care rather than discourage them if they wished refractive survey. We made certain they wen to the very best corneal surgeons.

There will be improvements in surgical techniques to make corneal refractive surgery even more safe and effective. It is the responsibility of every contact lens practitioner to understand what is now and future developments rather than be"unhappy with my assessment".

Don't shoot the messenger!
Click to expand...

If you go back and read some of my old posts very carefully, you will get a better picture of what I think. I think that all of the new technologies coming down the pike with respect to refractive eye care are benefitting our medical counterparts, thereby promising to leave us out in the cold, on the outside looking in. It's a shame that the only way we can participate is by shuttling our patients back and forth to the surgical suite. It's also a shame that I have to come up with creative ways to get into the ophthalmic meetings to see what's new and to go shopping for new toys.

I've also been around long enough to see that the prognostications of the Eric Donnenfelds of the world tend to be a bit forward looking and rosy. The end results is that we have a virtual epidemic of patients with altered corneas and dry eye, causing the renaissance of what was a nearly obsolete modality - the scleral contact lens, which in turn has boosted the RGP business and turned the GSLS into a world event.

We do have strength in numbers, and I hope that some day we can use that strength to leverage these companies to give us a closer look. Personally, I keep lobbying companies like Carl Zeiss to develop products that are more tailored for our needs and maintain lines of communication with their product managers. It's no accident that Carl Zeiss now regularly exhibits at the GSLS and has given the Visante new life by transplanting the anterior segment capabilities into its Cirrus line. I expect even better things in the future.

Editor's Note: GSLS is the acronym for Global Specialty Lens Symposium
 
Just to clarify, I am appreciative of Dr. Donnenfeld's contribution to ODWire.

I am all for new and better refractive technologies, such as SMILE, etc. It must be fun to be a refractive surgeon these days.

I was more irritated by Paul's dismissive remarks about eggs and baskets. In my practice this week were a couple of patients who did not fare so well with modern refractive technology. One was a patient with keratoconus whose vision in his good eye was made worse by CXL.

He couldn't get better than 20/40 vision with any contact lens. Thanks to our "eggs" we got him to 20/20. The other was a patient with LASIK induced keratoconus. He tried every conceivable lens in the UK before coming here.

We put a huge smile on his face with 20/15 vision and no glare whatsoever - even with his huge pupils at night. I should also mention the patient who was blind in one eye from ROP, and whose good eye was suffering from elevated higher order aberrations such that it curtailed his night activities.

We gifted him 20/10 vision. I don't think he would trust his only good eye to any kind of surgery.

Eggs? Maybe, but golden eggs.
 
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