
Subspecialty Day 2020 and the annual meeting of the American Academy of Ophthalmology (AAO) are going virtual this year. 

During the webinar November 13-15, registrants can participate in more than 100 hours of interactive broadcast content and learn about developments in research, clinical pearls, and practice management through the American Academy of Ophthalmic Executives (AAOE) program. 

There will be interactive opportunities to “meet the experts,” network with colleagues through lounge and happy hour events, and relax with stress-reducing activities at EyePlay Experience.

In addition to the broadcast content, more than 700 hours of on-demand education will be accessible until October 2021. AAO 2020 Virtual will provide more than 3 times as many on-demand hours as the 2019 program.

 is also part of the 2020 AAO program. Registrants can check out product innovations, learn about new services, and connect with industry representatives. Beyond the November webinar, the 

 will remain accessible through February 15.

Registrants for AAO 2020 Virtual will receive an All-Access Pass that will enable them to “attend” all sessions, courses, Subspecialty Day programs, and Skills Transfer courses that are partferti of the program. Physicians can earn up to 

™ through the virtual meeting, which is almost twice the number of CME hours offered during the 2019 program.

The decision to cancel the in-person meeting and hold an entirely virtual conference was made on July 13. Planning is ongoing. Program details will be provided as they become available and will be posted at 


The live, virtual meeting will begin each day at 7 am PST and end at 4 pm PST. Four, 75-minute live, moderated interactive sessions will be conducted outside of these hours to accommodate the schedules of registrants around the globe.

sessions will be held on Friday and Saturday evening (PST).

Hello, Europe, Africa, and the Middle East

! sessions are scheduled for Saturday and Sunday morning (PST).




The regular broadcast content on Friday, Saturday, and Sunday will begin with 30-minute opening sessions. 

On Friday, the opening session will feature addresses by AAO leaders, including current president Anne L. Coleman, MD, PhD; Maria M. Aaron, MD, secretary of the annual meeting; and David W. Parke II, MD, AAO chief executive officer. 

It will include formal recognition of the 2020 Guests of Honor, and it also will honor R. Michael Siatkowski, MD, recipient of the Straatsma Award for Excellence in Resident Education. Siatkowski is the David W. Parke II, MD, Endowed Professor and residency program director at the Dean McGee Eye Institute, The University of Oklahoma College of Medicine.

, considered the most distinguished lecture in ophthalmology, will be delivered by Michael X. Repka, MD, during Saturday’s 

. Repka is the David L. Guyton, MD, and Feduniak Family Professor of Ophthalmology at Johns Hopkins University’s Wilmer Eye Institute. He also is the AAO medical director for governmental affairs and the ophthalmology advisor for the American Medical Association’s CPT Advisory Committee. Repka’s opening session talk is titled “Amblyopia Outcomes through Clinical Trials and Practice Measurement: Room for Improvement.”

Tamara R. Fountain, MD, the 2021 AAO president, will speak during Sunday’s 

Friday is Subspecialty Day 2020. There are 9 meetings, each of which will have live broadcast content, as well as additional sessions on-demand.

> Glaucoma 2020: Winning Bets: Strategies in Glaucoma Care,

> Pediatric Ophthalmology 2020: The Only Game in Town,

> Refractive Surgery 2020: Celebrating 2020,

> Retina 2020: Vision for the Future (continues in the afternoon), and

> Uveitis 2020: Beating the Odds–How to Make Sure You Get a Full House When You’re Dealt Uveitis


> Cornea 2020: Seeing Clearly Into the Future,

> Ocular Oncology/Pathology 2020: Collaboration Now More Than Ever,

> Oculofacial Plastic Surgery 2020: Back to the Basics With Tips and Tricks, and


Saturday, November 14, and Sunday, November 15



The broadcast content on days 2 and 3 of AAO 2020 Virtual includes

 sessions, and other educational content. As in live face-to-face meetings, the 

sessions will include discussions by a panel of experts and their selection of best paper.

sessions will be available for viewing on-demand. 

 sessions also will be archived for on-demand viewing.


 will take place 9:20-9:40 am on Sunday as a virtual Zoom meeting. Login information for the annual business meeting will be provided in an email invitation that will be sent to voting members and fellows who are registered for AAO 2020 Virtual. After the meeting, voting members and fellows will receive election ballots for open board positions and amendments to the bylaws.

The annual business meeting will include a report from the president of the board and the executive vice president/CEO. It also will feature the election of fellows and members, new business and announcements.

AAOE, the AAO’s practice management affiliate, will offer instruction courses and panel discussions, many focusing on recovery from the financial and operational impacts of coronavirus disease 2019 (COVID-19). 

Instruction topics include finance, practice growth and optimization, consolidation, and coding. The interactive program will provide an opportunity to communicate with experts and colleagues.




Registrants can access the Academy Resource Center and will receive a 10% discount on clinical education, patient education, and practice management materials. In addition, they will get information on the IRIS Registry, coding, and the EyeSmart public information program, plus the opportunity to virtually “tour” the Truhlsen-Marmor Museum of the Eye.


Registration for AAO 2020 Virtual gives attendees an All-Access Pass with the opportunity to learn from all content. Attendees who purchased their pass before September 23 have been entered into a raffle for prizes including AAO membership in 2021, a free hotel stay during AAO 2021, and paid registration for Subspecialty Day 2021. If someone cannot attend the virtual, they still can register before Friday, January 29, and receive access to virtual meeting content through February 15.

Following is a listing of the registration fees by category:


Contact the Meetings Department staff by email.

General-meeting questions: meetings@aao.org

Registration, proof of attendance, and CME-related questions: registration@aao.org

Virtual expo questions: exhibitions@aao.org

Articles

With three days of content, expo will kick off November 13.

See page 6 of our October 1 issue: https://bit.ly/3iP5ERY 


AAO 2020 broadens opportunities with virtual meeting

The femtosecond laser is widely used in ocular surgery, particularly in refractive surgery with LASIK flap creation or small incision lenticule extraction, as well as in corneal graft or corneal inlays for keratoconus. 

Owing to the very short pulse of the laser, the technology provides highly precise ocular tissue cuttings without causing collateral damage to surrounding structures.

The application of femtosecond laser to cataract surgery was the obvious next step of the technology and has led to femtosecond laser-assisted cataract surgery (FLACS) emerging as a recent breakthrough. 



Femtosecond laser-assisted RLE offering better outcomes



However, it has required additional developments such as specific docking systems and real-time imaging to enable cuttings of the opacified crystalline lens to be made without distortion of ocular structures during the laser procedure. Safety zones to preserve surrounding structures within the eye also needed to be considered (

As expected, laser-created capsulotomy is more precise, circular and centered than manual capsulotomy. In addition, corneal incisions have more reproducible squared-edge architecture
and greater resistance to leakage than manual incisions using a calibrated knife. 

Furthermore, the fragmentation of the lens provided by the specific pattern of femtosecond laser impacts within the lens significantly reduces the amount of ultrasound used to remove the remaining pieces of the lens during the phacoemulsification phase.

Despite the femtosecond laser’s level of technical capabilities in cataract surgery,
the clinical benefit for patients remained unclear and a Cochrane meta-analysis could not determine the equivalence or the superiority of FLACS to phacoemulsification due to a low certainty of the available evidence and the unclear risk of bias in included studies.



Perioperative medications can eliminate postoperative drops after cataract surgery

With cataract surgery being one of the most routinely performed operations in medicine, it became clear that such a comparison was necessary, not just for patients but for healthcare professionals and decision-makers as well, to enable them to provide recommendations and potentially facilitate the spread of the technology.



The FEMCAT trial was a large-scale, independent, randomly assigned clinical study which took place at five centers in France. 

It was designed to compare anatomical, visual and refractive outcomes between FLACS and conventional phacoemulsification cataract surgery among 907 patients (1476 eyes) who received either bilateral or a unilateral cataract surgery by one of these two methods. 

We included a wide range of cataract severity grades that were likely to be representative of the French population who undergo cataract surgery every year in France.

The success rate was defined by four relevant outcomes in cataract surgery: the absence of perioperative complications up to the 3-month visit; a best corrected visual acuity of 0.0 LogMAR or better; an absolute manifest refractive error below 0.75 D; and the absence of significant change in corneal astigmatism between the preoperative visit at month 3 post-operatively.



Astigmatism management software proving to be accurate, precise

The femtosecond laser was found not to be superior to phacoemulsification in cataract surgery and thus FLACS failed to provide an additional clinical benefit for patients despite its advanced technical performance. 

Indeed, we observed a high rate of uncomplicated surgery of 94.2% up to the 3-month visit without significant difference between the two groups. These results were recently reported in The Lancet.

The rate of absolute manifest refractive error below 0.75 D or 0.5 D were up to 81.4% and 76.5%, respectively, again without significant difference between the two groups. 

Interestingly, we did not observe any difference in visual, refractive or anatomical outcome measures between the two groups whatever the cataract type or the cataract severity grade.



9 best practices in refractive-cataract surgery planning


In order to provide robust data on a large sample size, the FEMCAT trial was designed to minimize the risk of bias. 

We strived to provide masking procedures until the last follow-up visit wherever we could, including having a sham laser procedure for patients randomly allocated to the phacoemulsification group.

Additionally, an independent adjudication committee composed of three independent ophthalmologists masked to the trial allocation was designated to evaluate all adverse events for increasing objectivity in safety evaluation.

We also standardized all the associated procedures (IOL optical and biomaterial characteristics or phacoemulsification machines) in each center to limit the risk of bias and to analyze only the safety and efficacy profile of the studied surgical procedures. 

Finally, four surgeons experienced in cataract surgery were involved in the trial at each center. They were also likely to be representative of cataract surgeons
in France.


FEMCAT was also a cost-effectiveness trial and so we collected all direct expenses related to the surgery using a real-life micro-costing approach based on detailed resources used during the surgery. 

It included the prices of items such as knives, viscoelastic products, syringes or cannulas; the expense of the laser and disposable docking systems; and all of the costs related to phacoemulsification machines.


We also estimated all inpatient and outpatient costs, including those related to the follow-up or rehabilitation care arising until the treatment success measurement was obtained using the French national health data system, a claim database encompassing 98.8% of the French population. 


A new frontier in micropulse laser treatment for retinal disorders​ 


With comparable clinical outcomes between the two groups, the cost of FLACS was significantly higher and thus the laser was found not to be a cost-effective procedure for cataract surgery.

Indeed, all inpatient and outpatient costs as well as all direct costs of surgical items or phacoemulsification machines were not significantly reduced in the FLACS group. 

Thus the financial loss incurred by laser was not compensated, even in part, by either better clinical efficacy or a significant reduction in other direct costs during the surgical procedure or thereafter.

It is likely that the technology’s expansion will need to be facilitated by a significant reduction in femtosecond laser procedure costs in the future, including those incurred indirectly, for example by phacoemulsification machines that are used to aspire the fragmented lens.



Refractive outcomes soar with wavefront-guided technology system​ ​ 


The femtosecond laser was confirmed to be reliable and precise regardless of the cataract severity grade or the clinical experience of surgeons in our trial. 

Also noteworthy was that the laser enabled reliable images of the anterior structure of the eye to be obtained irrespective of the cataract severity grade, even for very mature cataracts, and allowed for reproducible cuttings of ocular tissues in the FLACS group.

Moreover, we did not observe any significant adverse event during the femtosecond laser phase. 

We reported only six cases of incomplete capsulotomy without subsequent anterior capsule tear. Ultrasound time and energy were also significantly reduced in the FLACS group. 

Finally, we can also confirm the learning curve of FLACS was short without significant adverse events seen in the first cases by each surgeon.



Laser cataract surgery making complex cases more routine


While FLACS does not provide an additional clinical benefit for patients over phacoemulsification cataract surgery today and was not found to be a cost-effective strategy in our trial, it is fair to acknowledge that this technology is still in its infancy and some perspective exists. 

Indeed, FLACS has provided new insights into anterior segment surgery, particularly in pediatric cataracts, by enabling posterior laser capsulotomy, which, when it is performed following crystalline lens extraction, could limit the risk of amblyopia related to the posterior capsule opacification.

Additionally, owing to the real-time imaging technology and the three- dimensional zones of laser treatment or safety zones the surgeon can define prior to the laser procedure, this technology can also improve the surgical outcomes of some severe anterior segment diseases such as severe capsulophimosis. 



Best anterior-segment imaging for corneal transplants

 that would be a better fit to the very precise and circular capsulotomy provided by the femtosecond laser machine could also help improve IOL stability or centration along the visual axis.

Furthermore, innovations such as new aspiration machines associated with the femtosecond laser could help limit the need to use the phacoemulsification machine and reduce the overall cost of the surgical procedure. 

Finally, FLACS may also pave the way to a new era of automation and robotics in cataract surgery.


IOLs offering treatment options for ophthalmologists 


Schweitzer is an ophthalmologist at Bordeaux University Hospital in France and is the principal investigator of the FEMCAT trial, which was fully supported by a grant for the French ministry of social affairs and health. The French ministry of social affairs and health did not participate in the collection, management, statistical analysis and interpretation of the data or in submitted manuscripts. Schweitzer has no financial disclosures.

The FEMCAT study found that FLACS is not superior to conventional approach 


Research: Femtosecond lasers  challenge phacoemulsification

This article was reviewed by Anthony Joseph, MD

Intravitreal injection of human retinal progenitor cells (hRPCs; jCell) is a novel treatment in development for retinitis pigmentosa (RP) that has demonstrated promising biologic activity and an excellent safety profile in a recently completed phase 2b study.

According to Anthony Joseph, MD, a primary investigator of the study, hRPCs offer a potential novel approach to the treatment of RP.

“The jCells exert their therapeutic effect by providing sustained expression of neurotrophic factors that are known mediators of neuronal survival, which both reduce photoreceptor death and promote the functioning of existing photoreceptors,” said Joseph, of Ophthalmic Consultants of Boston. “This paracrine mechanism of effect is thought to result in significant slowing of host photoreceptor loss and is agnostic to any genetic subtype.”



Gene therapy offers treatment for X-linked retinitis pigmentosa


Joseph reported findings of the phase 2b study on behalf of the study investigators at the American Society of Retina Specialists 2020 Virtual Annual Meeting in July.

In this study, 84 patients diagnosed with RP and with best-corrected visual acuity (BCVA) between 20/80 to 20/800 were randomly assigned to 2 doses of jCells, 3.0 x 106 or 6.0 x 106 or sham treatment. 

The primary end point was the mean change in the BCVA at 12 months; the secondary end points were identification of the lowest light level at which patients could ambulate through a structured mobility maze, along with the mapping of each patient’s kinetic visual field, the evaluation of their performance on contrast sensitivity testing, and completion of a low vision–specific quality-of-life questionnaire.



FDA grants fourth ODD for treatment of gene mutation-associated retinal diseases


Data were presented for a per-protocol population in which 10 patients were excluded from the randomly assigned population.

Joseph reported that an early and sustained nonsignificant change in BCVA was seen in the group receiving the 6.0 x 106 dose of cells in this population. Trends toward improvement were also seen in the other secondary end points, except for low-light mobility with the higher dose.

Joseph explained they identified a target population that excluded patients with testing variability: no central fixation, visual fields constricted to less than 12 degrees, and significantly worse vision in the study eye compared with the fellow eye.



Exploring novel gene therapy approaches to treat ocular disease

In a post hoc analysis of this target population (~50% of the per-protocol population), an early and significant improvement in vision was seen in the higher-dose group, with average gain of 16 letters at month 12 compared with 2 letters in the control group. 

The trend of improvement in the higher-dose group compared to the control group was also true for the secondary outcomes, he said.

“We outlined a target population that would allow more reliable testing of our subjects,” Joseph explained. “We will consider these guidelines for future studies.”



Stem cells for dry AMD show promise in early study

Some mild and transient intraocular inflammation was associated with the treatment in a few patients in both treatment groups. One case of severe ocular hypertension developed in the lower-dose group and resolved with treatment.


Intravitreal injection of allogeneic jCells showed promising results, with a trend toward BCVA improvement in the higher dose compared to control at month 12. 

According to investigators, the post hoc analysis of a more reliably measured target subpopulation suggested clinically significant improvement in BCVA in the higher-dose group compared to the control group, with a similar trend of improvement in the secondary end points. Intravitreal administration of these cells was well tolerated with a good safety profile.

“Considering the paracrine mechanism of this therapy, we do not expect permanent protection, and redosing of the current patients is planned,” Joseph concluded.



In study, treatment demonstrates promising biologic activity, safety profile

 Intravitreally injected hRPCs improve vision in retinitis pigmentosa cases

 images acquired using the new Heidelberg Engineering High Magnification Module provide high-quality images of the maculae in healthy eyes, but the images of eyes with 

This technology is integrated with widely available confocal scanning laser ophthalmoscopy (cSLO) in the Spectralis OCT system and is designed to obtain detailed photographic and videographic retinal images, said Eleni Konstantinou, MD.

“High-quality images of the retinal vasculature and photoreceptors may be useful for early diagnosis, prognosis, and monitoring the therapeutic response in retinal diseases,” Konstantinou said. 

But she also noted that it is challenging to obtain detailed images of the retinal structures at the cellular level because of the ocular optics.

New imaging modalities offering bold, noninvasive, real-time monitoring of retinal diseases


Konstantinou and colleagues conducted a pilot study to evaluate how well the platform performs when visualizing the retinal photoreceptor layer, retinal nerve fiber layer (RNFL), and superficial vasculature in healthy eyes and in those with retinal pathologies.

Thirty-two eyes, 16 with healthy maculae and 16 with pathologic maculae, were included. Both groups were imaged in vivo using the still and video platform modes, Konstantinou said. 

The images were classified based on their quality: Good was defined as visualizing the photoreceptors; average, not visualizing the photoreceptors; and poor, showing no identifiable structures.

The results indicated that in 12 of the healthy eyes (mean subject age, 34.6 years; mean best-corrected visual acuity, 20/20; refractive error range, plano –7.0 D), the images were classified as having good image quality—3 as average and 1 as poor.



Putting to practice retina innovations amid a pandemic

In the 16 eyes with a macular pathology (mean patient age, 58.7 years; best-corrected visual acuity, 20/20 to 20/400), 2 images were classified as good, 9 as average, and 5 as poor. 

These patients had epiretinal membranes (RM), age-related macular degeneration (AMD), central serous chorioretinopathy (CSC), nonproliferative diabetic retinopathy, branch retinal vein occlusion, diabetic macular edema, and macular edema.

Konstantinou noted that in the healthy maculae, there was better resolution of the parafoveal photoreceptors compared with the images of patients with CSC in which there was poor resolution of the fovea, parafovea, and perifoveal photoreceptors. 

In patients with an ERM, the striae could be visualized but the photoreceptors were obscured. In patients with AMD, the receptors were barely visible.



Characterizing localized retinal layer changes in AMD

“When assessing healthy eyes, the new module satisfactorily imaged the RNFL and superficial vasculature but could not visualize the photoreceptors in all eyes,” investigators concluded. “Generally, the image quality of the maculae with a pathology was limited, and the photoreceptor mosaic could not be resolved clearly in most images. Specific steps are needed to acquire good-quality images. Further studies are needed to clarify the imaging ability of this new module.”



Konstantinou has no financial interest in this subject matter. She was at the New England Eye Center at Tufts University School of Medicine in Boston, Massachusetts, at the time of this presentation.

High-quality images can be useful for early diagnosis, prognosis, monitoring

Ophthalmology Times: October 1, 2020

AAO 2020 broadens opportunities with virtual meeting

Research: Femtosecond lasers challenge phacoemulsification

Intravitreally injected hRPCs improve vision in retinitis pigmentosa cases

Retinal pathologies challenging to image with current technologies