Spectacular saves. Demoralizing outcomes. Innovative techniques. Each year’s Cataract Spotlight session offers attendees a panoply of cataract challenges. In this Q & A, Dr. Chang takes a look at the highlights.
BEGIN AT THE BEGINNING
What inspired the creation of the Cataract Spotlight?
As a member of the Annual Meeting program committee, I had been proposing a “Cataract Subspecialty Day” program for several years. I must have eventually worn Dunbar Hoskins down because he agreed to the idea in 2002.
His first two stipulations were that 1) it couldn’t be a Subspecialty Day program, and 2) it had to be scheduled during the main meeting. And he had a third: I had to be willing to organize the program (always the danger of volunteering any suggestion). Thinking it couldn’t hurt to ask, I requested the entire four-hour morning time slot, which I filled with 34 of the most prominent and popular cataract speakers lecturing on complications and challenging cases. Despite concerns that the session was far too long, attendance for that first Cataract Spotlight symposium exceeded everyone’s expectations, and more than 1,000 attendees signed a list to receive handouts by mail because we hadn’t printed enough.
What were some of the program’s innovations?
In 2005, we introduced live audience polling, which made the program more interactive, and this continues to be a regular feature. I am grateful that the Academy was willing to try this despite the considerable cost of renting the polling system and 1,500 response pads. The inaugural Kelman Lecture was also that year, and Charlie’s 13-year-old son Evan presented the plaque to Howard Fine.
In 2010, Cataract Spotlight became the first major symposium to show 3-D video. Not only did TrueVision provide thousands of cardboard 3-D glasses, but they also had to erect a special screen and twin projector tower—their first attempt at projecting 3-D video in a ballroom of that size. We also introduced virtual streaming in 2015. Thanks to this, one attendee gratefully wrote that she didn’t have to miss the symposium because she could watch from home while breastfeeding her newborn. I presume that our content kept that infant asleep for all four hours.
Also, in 2009, the program committee created an all-day Cataract Monday by annually scheduling the ASCRS symposium and other cataract sessions in the same room during the afternoon.
UNEXPECTED. (1A) This image shows retained cortex and a large stromal iris defect temporally. (1B) Following cortex removal and IOL centration, the defect persisted. (2A) The lens fell early in this case. (2B) A V-groove nucleofractis technique was used to eliminate the need for hydrodissection.
EVOLUTION AND ENDURANCE
How has the format evolved?
For the first six years, the symposium’s theme rotated between complications, IOLs, and controversies, with each featuring more than 30 rapid-fire lectures. In 2008, we changed the focus to surgical decision-making by analyzing seven video cases showing complications and surgical challenges. These cases from the moderators’ practices were paused at multiple points for the audience to decide (using their response pads) how to proceed.
Although we continued to have short lectures relevant to each presented case, we also moved permanently to a panelist format. After voting and then seeing what their fellow attendees would do, the audience got to see how well the panelists could think on their feet before they saw the eventual outcome. We continue to use this case-based format—entitled “You Make the Call”—and it will be featured in this year’s meeting.
Our other formats are called “M&M Rounds” and “My Top 5 Pearls.” “M&M Rounds” debuted in 2011; for this, we asked 18 faculty members to share a complication video so that our audience could learn from their mistakes. Inspired by Bob Osher’s willingness to show his worst complications, this was a deliberate departure from typical programs where the faculty showed their best surgical triumphs. Amar Agarwal annually stole the show with heart-stopping videos.
As for “My Top 5 Pearls,” it was introduced in 2016. Presenters concisely summarized just five pearls for their topic in a lightning fast, seven-minute talk, enforced by a visible timer counting down to a shot clock buzzer. As Steve Safran correctly inferred, the assignment was to serve just the meat without the potatoes.
Why do you think the Spotlight’s popularity has endured?
As with the Subspecialty Day programs, attendees get a concentrated program— in this case, focused on cataract—and do not need to leave their seat all morning. Its popularity is entirely due to the all-star assembly of international faculty. I’ve had the privilege of comoderating with Howard Fine, Skip Nichamin, David Apple, Mark Packer, Bruce Wallace, Bill Fishkind, Mitch Weikert, and now Nicole Fram; the last five were my successors as chair of the Annual Meeting’s Cataract Program Subcommittee.
One final note on staying power: We are still the only ophthalmology symposium where the moderators must endure more than four hours straight without a bathroom break, which has definitely become more challenging for me compared to 20 years ago!