Kerry Solomon, MD, an eye surgeon at Physicians' Eye Surgery Center in Charleston, S.C., is scheduled to perform laser cataract surgery at the ophthalmic ambulatory surgery center on Oct. 22. The procedure will be broadcast live at the annual meeting of the American Academy of Ophthalmology in Orlando.
Dr. Solomon is also the co-founder of Operation Sight, a not-for-profit organization that provides cataract surgery at no cost to area residents who are uninsured and cannot otherwise afford the surgery.
He discusses the live broadcast, how laser cataract surgery might impact ophthalmology and his hopes for Operation Sight.
Q: Can you provide an overview of how this live broadcast came together and how you became involved?
Dr. Kerry Solomon: There are typically live surgery events at both the AAO and the American Society of Cataract and Refractive Surgery meetings. As it relates to this year's meeting with the Academy, I was approached to see if I would be willing to host it. I'm sure part of the reason was the technology that we have (the Alcon LenSx femtosecond laser). This will be the first time the femtosecond laser will be used and demonstrated live at the AAO.
Q: Why did you want to be the surgeon who performed the live surgery?
KS: It's a good opportunity for people who are going to be attending the AAO [meeting] to have a first-hand glimpse, live, of what the technology looks like, how the flow will work, how the procedure will work and what the patient's experience is. I think that's all educational.
The procedures will be performed by [me] and by a dear colleague of mine, Dr. Richard Mackool from New York, who will be coming down. He'll be performing a case as well.
Some of the things we will be demonstrating will be the correction of astigmatism with the femtosecond laser. The case I will be performing will combine the correction of astigmatism with the femtosecond along with the use of a Toric IOL. My experience has been that combining the two technologies has the potential to titrate the astigmatism reduction to a very low level.
Dr. Mackool will be using the technology to treat astigmatism in someone who is also interested in near and far vision. He will be correcting astigmatism and presbyopia with a multi-focal lens. The astigmatism will be corrected with our femtosecond laser. Then he'll be using a multi-focal lens to correct the presbyopia.
Q: What do you hope attendees at the AAO meeting will learn from the live surgery?
KS: We're seeing an evolution in cataract surgery where more of today's cataract patients are living longer, they're leading more active lives and they are very interested in being less dependent on their glasses and contact lenses. The term for that is "refractive cataract surgery." The two cases we'll be presenting will not only be effective techniques to remove the cataract, but in one instance, [it will be] to treat very large levels of astigmatism to allow someone to achieve spectacle independence for their distance activities and they'll use reading glasses. In the case of the other patient, they'll be able to have spectacle independence for their distance and near activities.
Hopefully, both [surgeries] will educate surgeons who are watching on how to educate patients about the different technologies, how to determine which technology and treatment is going to be best for each patient, and what the realistic goals and expectations can be from a patient's perspective. At the end of the day, it's about giving patients all of the information they need to make good decisions with a goal of improving someone's quality of life by letting them be less dependent on glasses and contacts for their daily activities.
Q: How do you think laser cataract surgery and this technology will change ophthalmology?
KS: It hasn't yet. Whenever a laser has been introduced into a procedure, over time that procedure becomes more efficient and it actually improves. That's the potential [for] this laser. This laser has the potential to do things and advance our techniques beyond where they currently are. For example, we can cut different shapes of incisions for the primary incisions for cataract surgery. Instead of just rectangular or square incisions, we're now doing trapezoidal incisions. There are some benefits to that in terms of reducing the amount of astigmatism, minimizing any extension of tissue trauma. We can get capsulotomies — openings into the cataract that are more circular than what we can do manually.
There is some preliminary data coming out that shows the effective lens position, where the lens implant resides after cataract surgery, is more predictable. It's just to a small amount, but it is still more predictable in patients who have undergone a procedure with a laser involved in a cataract removal compared to manual techniques. That's in my own cases. I feel I do a good job with my manual techniques. I was not expecting to see a difference between the manual and laser patients in my practice, and yet the data is very consistent in showing small improvements in the lens positions. From a patient's standpoint, that may mean better 20/20 rates without glasses. The data is still preliminary. Larger data sets with longer follow-up are underway.
For the treatment of astigmatism, the arcuate incisions are absolutely exquisite and they have great potential to more precisely reduce astigmatism in conjunction with Toric IOLs. It's exciting, it's new. I would not say manual surgery is obsolete, but I do think the technology offers some wonderful potential for the future.
Q: What do you envision for Operation Sight?
KS: Operation Sight is just getting started. It is an initiative that I have undertaken along with one of my partners, and dear friend, Dr. John Boatwright. It's an initiative supported by all our partners at Carolina Eyecare Physicians and our surgery center, the Physicians' Eye Surgery Center.
The basic concept of it is this: Many of us, myself included, we travel around doing missionary work around the world. We provide care where care is needed. It's a wonderful way to give back. And yet, the economy is not in great shape in the United States. There are more people out of work and without insurance. It really dawned on me that we should continue to help areas around the world, but we also ought to be able to take care of our own, take care of our neighbor. One of the main goals of Operation Sight is to be able to provide cataract surgery for those patients who have significant cataracts, but have no insurance and no funding.
Our initial concept has really come to fruition. It's taken a lot of meetings and a lot of organization, and I need to credit my wife, Cindi Solomon, who is the director of it. We are forming a 501(c)(3), a not-for-profit status. We are developing a board. We are raising money. We have really been very successful at trying to integrate Operation Sight into all of the different healthcare networks around this part of the state. We've partnered with United Way [through its] initiative called Access Health which basically provides for primary care and it serves all healthcare systems in this part of the state. That's a nationwide initiative of Untied Way. We have also partnered with Commission for the Blind and Association for the Blind, and they have been wonderful in helping to screen patients. Association for the Blind will also be providing glasses postoperatively. We have been able to work collaboratively with the local Charleston optometric society here in South Carolina to also provide assistance. We'll have a large group of healthcare providers to help provide pre-op care, surgical care and post-op care.
The way it would work is patients would be identified. They will be referred into the system. Their eligibility for funding will be verified and if they qualify, they will then be sent out to an eye care provider. If they're identified that they do indeed have a visually significant cataract, they will officially be put into the Operation Sight system. They will be seen by myself, Dr. Boatwright or any of the other participating ophthalmic surgeons. They'll have their cataract removed at the Physicians Eye Surgery Center or other participating surgery center. Anesthesia services have also been donated by Anesthesia Associates of Charleston, the anesthesia group that works with our surgery center. The patient will then be plugged back into their eye care provider for their post-op care and then back to Access Health for their general care. Glasses will be provided by the Association for the Blind. Most of the services are donated but we are raising money to handle our hard costs.
Both of our patients for the AAO live surgery event will be recipients of Operation Sight. The first is a 63-year-old woman whose best corrective vision is 20/200. She's a teacher. She can't drive a car, she can't read, she can't get a job. She wants to be a productive member to society but she just has no means, nor does she have insurance for her cataract surgery. She reached out to us via the Internet and learned about Operation Sight. She's a delightful woman and our goal is to remove her cataracts, which I think is the only thing limiting her vision, and let her become a productive member of society.
Our second recipient is 59, also has no insurance and is out of a job. Her best corrective vision is 20/80 in each eye. She also cannot legally drive a car. In both instances, these people want to contribute back to society. But when you can't drive, you can't watch television and you can't read because of your vision, it's not only affecting your quality of life but it's affecting your ability to be a productive member of your community. We're thrilled to be able to offer this and hope we can make a meaningful difference in patients' lives.
It's wonderful to have an opportunity to give back. If this is successful, I think it would be great to expand this to all of South Carolina, and maybe this can be recreated in other states. I do believe these are tough times for everyone and we all should be doing our best to chip in.
Learn more about Physicians' Eye Surgery Center, Dr. Kerry Solomon and Carolina Eyecare Physicians. Thank you to Medical Consulting Group for helping to arrange this interview.
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