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Ive been involved with the ESCRS since the late 1980s when it was the European Intraocular Implant Club, and have been to every meeting over the past 25 years. Ophthalmology and cataract surgery has been my career but also my consuming interest too, and the lines between work and leisure don’t exist which is very nice. It is a wonderful career and I’m actually jolly lucky.


It is a tremendous privilege to take over the presidency, but is also a big obligation to keep it running as well as it is at the moment with the changes that we face in the future. The powerhouse of the ESCRS is always going to be our meeting in September. It’s a superb meeting and I’m always amazed at the quality and expertise of the speakers and their presentations. I think it is very important so that we are not just a once-a-year thing, but a resource throughout the year, and I see us further consolidating our teaching and training role outside of the meetings by expanding the eLearning platform and our video libraries.


Our involvement in research is also going to become very much stronger, building on the back of the endophthalmitis work, which has been absolutely fundamental. Our investment in research is something like €1.4million and we have two really big, heavyweight, excellent projects going on at the moment. Firstly there is the PREvention of Macular EDema after cataract surgery (PREMED) study. It is a massive multicentre project headed by Rudy Nuijts and we have just agreed to finance a project investigating the genes for keratoconus and ectasia.


The progress that ophthalmology has made since I first started doing cataract surgery is amazing. The quality of surgery has improved out of all recognition. When I trained as a resident in Moorfields, we were trained to perform intracapsular surgery with no intraocular lens. Over the years, I’ve seen the evolution from intra-cap to extra-cap to phaco and now to femto. Other major milestones during those years included the introduction of Healon, which made intraocular surgery safe, and posterior chamber lenses.


We are now in a very exciting time. I’m sure that femtosecond laser-assisted cataract surgery is here to stay. All the present studies show that femto is no different from the visual outcome point of view, but it makes the surgery much easier, and as the technology improves the results will surely get better. The question is, how do you integrate that into a public health service? I think that's a major challenge, but I think it's going to happen and it will probably change how we practise. The economics of this and other expensive technology will probably force us into working in bigger, higher volume units.


I think we’re also going to see accommodative intraocular lenses coming in over the next three to five years, where the change of focus will depend on the optic’s change of curvature rather than its change of position. That is really the Holy Grail and there are several of these lenses under development at the moment. Glaucoma will also most likely become much more surgically treatable, and I think we should be moving away from keeping patients on lifelong drops and over to micro-incision glaucoma surgery using the new developments in stents and snorkels.


I recently retired from St Thomas’ Hospital, but I continue to run a large private practice. I’m also a trustee of the major British eye research charity, Fight for Sight. We’re going to spend £20million in research over a five-year period. But you never have enough money for research. It is the same situation with the ESCRS.


We should be promoting increasing quality of surgery with safer surgery and better outcomes. I think we are going in the right direction, but the financial challenges that we're going to face in the next few years are going to be a major problem.


In Britain, for example, it is forecast that the NHS (the public service, free at the point of delivery to patients) will have a shortfall of £8billion in six years’ time. So there’s not going to be a lot of spare money around, and already there are big financial pressures on the public and private systems. While our practice expenses go up, our reimbursement rates are going down. Therefore, we will really have to focus on what patients need and on patient reported outcomes. We have to think about what’s best for the patient and that will see us through.


David Spalton:

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