Dr. Steve Arshinoff (centre) with Mr. Paul Rosen (left) and Mr. Donald J. Munro (Rayner)
In 1978 the UK Intraocular Implant Society (UKIIS), the forerunner to The UK and Ireland Society of Cataract and Refractive Surgeons (UKISCRS), invited Rayner to sponsor a special lecture to be given every two years at a meeting of the Society. The Rayner Medal Lecture is undoubtedly the most prestigious medal lecture of the society and has been awarded to many of the world’s leading authorities on intraocular lenses and other aspects of cataract and refractive surgery.
Previous Rayner Medallists include:
The Rayner Medal Lecture this year (2006) was given by Steve Arshinoff, Toronto, Canada and was entitled “Ophthalmic Viscosurgical Devices”.
Dr. Steve Arshinoff MD FRCSC is a graduate of McGill University, Montreal, Canada and of Baylor College of Medicine, Houston, Texas, USA with a special interest in ophthalmic viscosurgical devices (viscoelastics).
Dr. Steve Arshinoff
Understanding OVDs is essential to good cataract surgery. “Cataract surgeons should keep available a range of ophthalmic viscosurgical devices (OVDs) with differing fluidic properties as no currently available OVD will be adequate on its own for every eye and in every surgical situation”, said Steve Arshinoff MD in his Rayner Medal lecture at the annual meeting of the United Kingdom and Ireland Society of Cataract and Refractive Surgeons (UKISCRS), which was held in conjunction with this year’s Annual Congress of the ESCRS. “Different OVDs are best used for different things. You have to have more than one in your surgery and not just get the cheapest one you can find that will only do one thing for you and not do multiple different things”.
He also emphasised that cataract surgeons should have a thorough understanding of the classification of OVDs, so that they may use each device to the best advantage during the course of surgery. He noted, for example, that the lower viscosity dispersives are better at remaining in the eye during phacoemulsifcation at high flow rates than the high viscosity cohesives. On the other hand, highly viscous OVDs provide better anterior chamber stability and endothelial protection and are easier to remove from the eye at the end of surgery. Viscoadaptives, meanwhile, have good retention in the eye and provide good anterior chamber maintenance but can be difficult to remove because they fracture on the edges of IOLs under high vacuum. It was for these reasons that Dr Arshinoff developed the soft-shell technique, which uses two different viscoelastics in the same procedure and the ultimate soft-shell techniques, which use a viscoadaptive OVD in combination with Balanced Salt Solution (BSS).
“The idea of the soft-shell technique is to take two of the most different OVDs we could find in the market place, a highly dispersive and a highly viscous cohesive, and use them together without letting them mix to achieve the benefits of all the classes of OVD we have at the same time”, Dr. Arshinoff explained. The ultimate soft-shell technique was designed to take advantage of the versatility of viscoadaptives and at the same time get around their drawbacks by using BSS in the place of a dispersive OVD, he added.
Dr Arshinoff also noted that advances in rheological science have led to the development of new systems of classifying OVDs. This has in turn led not only to the development of new OVDs with novel properties but has also pointed to potential new OVDs with properties that don’t exist in currently available products. He added that the history of ophthalmology as well as other sciences has shown time and again the importance to research of individuals who learn to look at things in a new way and challenge conventional wisdom. “Every one of us can contribute to the development of ophthalmology. You have to stand up there and tell the world what you think because you never know where the next new wonderful idea will come from.”
(Account of this year’s Rayner Medal Lecture courtesy of Eurotimes)
