American Academy of Ophthalmology—1979 Meeting

AMERICAN JOURNAL OF OPHTHALMOLOGY™ FRANK

W.

NEWELL,

Editor-in-Chief

Tribune Tower, Suite 1415, 435 North Michigan Ave., Chicago, Illinois 60611

EDITORIAL BOARD Mathea R. Allansmith, Boston Douglas R. Anderson, Miami Crowell Beard, San Jose Bernard Becker, St. Louis Benjamin F. Boyd, Panama Charles J. Campbell, New lork Ronald E. Carr, New York Thomas Chalkley, Chicago Claes H. Dahlman, Boston Fred Ederer, Bethesda

DuPont Guerry III, Richmond Robert W. Hollenhorst, Rochester Herbert E. Kaufman, New Orleans Arthur H. Keeney, Louisville Carl Kupfer, Bethesda Irving H. Leopold, Irvine A. Edward Maumenee, Baltimore Irene H. Maumenee, Baltimore Edward W. D. Norton, Miami G. Richard O'Connor, San Francisco

Arnall Patz, Baltimore Steven M. Podos, New lork Albert M. Potts, Louiscille Algernon B. Reese, New York Robert D. Reinecke, Albany Marvin L. Sears, New Haven David Shoch, Chicago Bruce E. Spivey, San Francisco Bradley R. Straatsma, Los Angeles Gunter K. von Noorden, Houston

Published monthly by the Ophthalmic Publishing Company Tribune Tower, Suite 1415, 435 North Michigan Avenue, Chicago, Illinois 60611 Directors: A. EDWARD \1AUMDiEE, President; DAVID SHOCH, Vice President; FRANK W. :"EWELL, Secretary and Treasurer; EDWARD W. D. NORTON, BRUCE E. SPIVEY, BRADLEY R. STRAATSMA

AMERICAN ACADEMY OF OPHTHALMOLOGY-1979 MEETING The American Academy of Ophthalmology Meeting was held in San Francisco Nov. 4-9, 1979. The number of registrants at this meeting approached 14,000, which represents the largest number of ophthalmologists and ophthalmic associates ever to attend a meeting of the American Academy of Ophthalmology. It is probably the largest attendance of ophthalmologists at a single meeting in this country. Hundreds of the registrants were from foreign countries, such as England, France, Italy, Brazil, Argentina, Mexico, Japan, Germany, India, Egypt, Israel, Iran, Sudan, Australia, New Zealand, and China. The atmosphere was one of joint interest and a great desire to be up-to-date. The many attractions of San Francisco were competition for the cornucopia of information available at this year's meeting. As with previous meetings, there were countless breakfast meetings,

luncheon meetings, receptions, alumni meetings, gatherings of old friends, former residents, teachers, colleagues, and recruitment activities. The scientific meetings took place simultaneously in the three main halls. Often, teaching sessions coincided. Numerous excellent scientific exhibits were available, as well as impressive displays by the technical exhibitors. The new instruments were exciting, some costing the equivalent of two to three or four thousand refractions. It is difficult to recall the old days when mechanical automated refractors and perimeters were not available. How did we ever do it? Scientific sessions started at 9 A. M. and continued through until 7 P.M. to 10 P.M. each day. At times, the attendees had to make tough decisions as whether to participate in a course, a major meeting, or see the exhibits; the offerings in each category were most attractive. The logistics of this meeting offered a

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difficult challenge. However, under the statesmanlike leadership of Frederick C. Blodi, president of the American Academy of Ophthalmology, and the extremely competent management of Bruce E. Spivey, executive vice-president and his well-rehearsed staff, the meeting was an outstanding success. Each of the sessions was kept to a disciplined time schedule. The sessions were chaired by the president, Frederick C. Blodi; the president-elect, Edward W. D. Norton; the first vice-president, Kenneth C. Swan; the second vicepresident, Goodwin M. Breinin; and third vice-president, Robert C. Drews. Additionally, there were so many sessions that past presidents, Frank W. Newell, Bradley R. Straatsma, and Kenneth L. Roper were called into presiding action, as well as the councillors, Thomas D. Duane and Whitney G. Sampson; the editor, Stanley M. Truhlsen; and the secretaries, Robert D. Reinecke and David Paton. Although the official opening did not take place until Monday morning, Nov. 5, scientific sessions were available on Sunday evening, Nov. 4. A combined meeting of the Academy with the Contact Lens Association of Ophthalmologists, dealing with the present status of extended-wear contact lenses and intraocular lenses, drew an overflow crowd. At the same time a combined meeting of the American Association of Certified Orthoptists and the American Orthoptic Council discussed diagnostic and surgical procedures in strabismus surgery; it was also well attended. Concurrently, the American Society of Ocularists considered the problems of enucleation, the imperfect socket, and prosthetics. The impressive attendance at all of these sessions, the night before the opening sessions, was a clear indication of what was going to take place at each of the meetings throughout the week.

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The scientific program had something for almost every interest in ophthalmology. Surgery, retinal detachments, cataracts, strabismus, tumors, medical therapy of glaucoma, infections, uveitis, contact lenses, intraocular lenses, new surgical techniques, ocular manifestations of systemic disease, radiological diagnosis, computed tomographic investigations, diabetes, vascular occlusions, and macular edema were all considered. Each subject was considered in depth. Six hundred twenty-three instruction courses, 60 elective scientific exhibits, and 80 scientific posters were provided. Frederick C. Blodi officiated at the opening session in the large room of the Convention Hall at 9 A.M. on Monday, Nov. 5. After announcements by Bruce Spivey, the honor awards were presented to 32 recipients. The guests of honor, Professors Akira Nakajima of Tokyo, Japan; Frank W. Newell of Chicago; and Gerhard R. E. Meyer-Schwickerath of Essen, Germany, were presented. The Lions International received the Public Service Award. In presenting the XXXVI Edward Jackson Memorial Lecture, Herbert E. Kaufman discussed the methods of correcting the visual impairments of aphakia, in his characteristically clear, confident, relaxed, and competent style. Spectacle lenses, contact lenses, extended-wear lenses, intraocular lenses, keratomileusis and keratophakia were all considered. He also introduced a method of keratophakia that uses preformed preserved corneal material. This technique might do away with the necessity for complex and expensive computerized lathing equipment. Perhaps, with this method the corneal disk could be prepared at a central laboratory. However, this technique requires long-term evaluation. Dr. Kaufman also discussed corneal and epithelial replacement as advocated

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by Jorge Alvarado and Denis Gaspodarowicz, Gary Greenburg and Steven Kramer. This was a thorough and encouraging summary of the methods, problems, and possibilities for handling aphakia and the complications of aphakia, especially corneal involvements. An outstanding virology symposium under the direction of Anthony B. Nesbum followed. The symposium was aimed at the busy practitioner of ophthalmology. The speakers updated the knowledge of viral infection and the changing concepts in the pathogenesis of viral disease. Although the adenoviruses, cytomegalic inclusion virus, herpes simplex, and herpes zoster were considered in detail, there was still adequate discussion of slow viruses; for example, Creutzfeldt-Jacob, Scrapie, Kuri and subacute sclerosing panencephalitis. The role of virus in tumor formation and the influence of immune and antimetabolite therapy were reviewed. A symposium on ocular trauma and the role of vitrectomy in its management was enhanced by an enlightening discussion of sympathetic ophthalmia by Dr. Blodi. A huge crowd attended a symposium on the surgical and medical management of glaucoma. It was instructive to learn of the number of side effects that are now encountered with timolol. There also seems to be a general agreement that in time there may be some loss of effectiveness. The early investigations of timolol had suggested freedom from side effects. The experienced glaucoma therapists indicated that the side effects are more frequent than anticipated; these include hallucinations, light-headedness, sencopy, bradycardia, asthma, congestive heart failure, increased blood pressure, headache, eye ache, superficial punctate keratitis, and blurred vision. We learned of these side effects from E. Michael Van

JANUARY, 1980

Buskirk, Richard P. Wilson, and George Spaeth. In the program of the Drug Committee of the Academy, George F. Hatch described acute central nervous system disturbance from retrobulbar subdural injections. Richard K. Forster, Richard L. Abbott, and Henry Gelender discussed the management of infectious endopthalmitis with intracameral antibiotics and vitrectomy. John R. Wood, Richard L. Anderson, and James J. Edwards stressed the importance of pressure on the punctum to reduce the systemic absorption of any topically applied agent. Frederick T. Fraunfelder reviewed some of the side effects of timolol that had been reported to the National Registry ofInduced Ocular Side Effects as well as those of other drugs. Theodore Krupin, Barry Silverstein, and Bernard Becker described the topical hypotensive action of antazoline. Frank Dea, John Valentine, and Irving H. Leopold discussed how aspirin taken orally can appear in measurable quantities in the tears. Roswell R. Pfister pointed out that ascorbic acid may be helpful in the treatment of ocular alkali bums. Antiproteolytic enzymes' presence in human tears was noted by Janet Anderson. Anthony Bron, a guest of the Drug Committee, gave a delightful presentation of the management of corneal disease. There was a symposium on ocular inflammations and uveitis and conditions associated with dermatologic disorders. At the same time, there was a symposium in conjunction with the ophthalmology section of the Council of the American Medical Association, chaired by Thomas D. Duane, co-chaired by Oliver H. Dabezies, in which Alfred Kopf was introduced by Joseph Wadsworth. Dr. Kopf presented the Parker Heath Memorial Lecture. It was a detailed and

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thorough discussion of cutaneous malignant melanoma and a multivariant computer analysis of the many factors that can accurately predict the outcome. These varients include the histologic features, such as thickness, mitosis per square millimeter, and melanin content. Also covered were clinical aspects, such as size, location, and surface characteristics. Lorenz Zimmerman illustrated the manner in which ocular melanotic tumors differed and resembled skin tumors. Diagnostic and therapeutic approaches were evaluated together with the nature and course of untreated melanoma. Concurrently, methods of evaluating retinal function were scrutinized. Neovascular glaucoma was considered in detail in a meeting of the National Society to Prevent Blindness. The program was set up by Alan Kolker. Particular attention was paid to the management of aphakic individuals with glaucoma. The program of the American Society of Ophthalmic Registered Nurses was coordinated by Heather Boyd-Monk. Vitrectomies were considered in depth at a meeting organized by Mackenzie Freeman. The role of vitrectomies was detailed in cystoid macular edema in diabetic patients with traction retinal detachments, in endophthalmitis, and in diagnosis of lymphoma. Cystoid macular edema, Purtscher's disease, retinal hemorrhages, vascular occlusions, orally administered fluorescein, angiogenesis factor, a variety of diabetic retinopathies, and the use of intracameral hyaluronic acid were discussed. The symposium on radiologic analyses and computed tomographic ophthalmographic investigations of muscles, optic nerves, orbital tumors, and lacrimal gland tumors was well presented. The prognosis and management of these conditions were considered in depth.

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A joint meeting of the American Association of Ophthalmology considered the impact of federal regulations on ophthalmologic care. At the meeting of the American Intraocular Implant Society, a huge audience gave a great deal of attention to the intraocular lens implants. Results in over 100,000 intraocular lens implantations were reviewed by the Advisory Ophthalmic Device Section of the Food and Drug Administration, presented by its chairman, David Worthen. At this same session a symposium considered intracapsular vs extracapsular extraction for intraocular lens implantation. Norman Jaffe made the Ridley 30th anniversary presentation and Henry Hirschman delivered the Fifth Binkhorst lecture. Dr. Hirschman suggested that the 1980s will be a decade of the lens implant, but with a strong trend toward the use of extended-wear contact lenses. He anticipated that there will be significantly fewer spectacle lenses used for the correction of aphakia in the next decade. There was a meeting for those interested in keratoplasty, the storage and preservation of corneal material for grafting. Tumors and reconstruction of the eyelids were considered in detail. Aspects of pediatric ophthalmology were covered. A combined meeting of the Castroviejo and the International Corneal Societies discussed anterior-segment surgery in relation to trauma, intraocular lens, endothelial transplantation, the effects of growth factor on wound healing, methods of evaluating stress on a corneal wound, and techniques for handling keratophakia. The session finished on Friday morning with a combined meeting of the David J. Kelman Research Foundation and the American Intraocular Implant Society. Though this was the last day of the Academy meeting, the Implant Soci-

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ety planned to continue their meeting for the next two days. Lawrence Pape and Endre A. Balazs discussed the use of hyaluronic acid, as did David Miller and Robert Stegman, on intraocular lens implant and its effect on the ocular tissues. Anterior chamber Huorophotometry, as a measurement of retinal vessel leakage in diabetic patients was critiqued. Consideration was given to extraction of displaced cataracts, cataracts in the presence of detachments, glaucoma, uveitis, and vitreal disease. Edward Fetherolf, Miles Galin, Ira Goldstein, and Robert Buys explained the induction of inflammation caused by the intraocular lenses. The exhibit, "Racket Sports and Eye Injuries-Are They Preventable," by Michael Easterbrook was selected as the prize winner, but it was only one of many excellent scientific exhibits. The meeting provided a great opportunity for each ophthalmologist to fill gaps in knowledge, acquire new information, and strengthen knowledge gained in the distant and recent past. This was a most convincing proof of the constant, strong desire and effort of ophthalmologists to be prepared to handle their patient problems. Could the meeting be improved? Of course there are always suggestions for that, but I doubt it. Initially it seemed overwhelming in its scope, hut as the week wore on, participants began to handle the information challenge with ease and expertise. Possibly a greater effort in selection of material and fewer simultaneous sessions could make it easier for an individual who has difficulty selecting where to go, as each of the papers presented is not of equal quality, However, there is no way to eliminate attractive papers fairly, An attempt by a special Academy Selection Committee could be made, but I doubt whether they

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could do a better job. It is much simpler for the specialist, of course, to be able to select, whereas the generalist who wants to gather as much information as possible in many areas, has pressure and strain in trying to get the most out of this tremendous amount of information. However, even this could be handled by a careful perusal of the program and the selection of the areas one wants to attend, well in advance of the meeting time. True, the attendee may have to stand at some of the sessions, as he moves from one hall to another, but this is a small price to pay in order to have such a wonderful array of exciting new information. Edward W. D. Norton will be the president of next year's Academy. David Shoch is the president-elect and Theodore Steinberg has been elected the new councillor for the Academy. Jerome Bettman is first vice-president, Alice R. McPherson is second vice-president, and Fred M. Wilson is third vice-president. Robert D. Reinecke is the designated representative delegate for Washington affairs; secretary for instruction is Melvin L. Rubin; secretary for continuing education is David Paton. Paul Henkind replaces Stanley M. Truhlsen as editor for Ophthalmology. Whitney G. Sampson will continue as councillor through 1980; Marshall M. Parks, councillor through 1981; and Thomas D. Duane as councillor through 1982. Under the guidance of these officers, plans are underway for the next annual meeting of the Academy in New Orleans, Nov. 13-17, 1980. The 1981 meeting will be held in Atlanta, Georgia, Nov. 1-.5. In 1982, in San Francisco, will be a combined meeting of the American Academy of Ophthalmologv and the XXIV International Congress of Ophthalmology Oct. 31- Nov. 5, 1982. By that time this Academy will have vast experience in handling huge crowds of attentive, information-craving ophthal-

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mologists. The new San Francisco convention center and facilities should be completed in ample time for the meeting. IRVING H. LEOPOLD OBITUARY

J. Kimura, M.D. 1912-1979 Samuel J. Kimura, professor of ophthalmology emeritus at the University of California's School of Medicine in San Francisco, died unexpectedly in Granada, Spain, Oct. 15, 1979. His many friends and professional colleagues mourn the passing of a gifted teacher, a superb physician, and an innovative researcher. Dr. Kimura was born in Stockton, California, on April 21, 1912. After gradSamuel

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uation from high school, he entered the University of California at Berkeley where he obtained both the Bachelor of Arts and the Master of Science (anatomy) degrees. He received his M. D. degree from the University of California in 1940, and after a year of internship in Chicago he joined the Army, serving in the Medical Corps in southern Europe. He later returned to California to enter the ophthalmic residency program of the late Frederick C. Cordes, M. D., in San Francisco. While in this program he made his first contacts with Phillips Thygeson, M. D., and the late Michael J. Hogan, M.D., men who were to influence his later career in inflammatory diseases of the eye. Dr. Kimura was known for his manv contributions to the fields of uveitis and external diseases of the eye. In collaboration with other members of the Francis I. Proctor Foundation for Research in Ophthalmology, he established the importance of lysozyme deficiency in keratoconjunctivitis sicca, he demonstrated the presence of herpes virus in the corneal epithelium by means of fluoresceintagged antibody; he made significant observations on the pathogenesis of herpetic uveitis and on Fuchs' heterochromic iridocyclitis; he studied and classified many forms of uveitis associated with inflammatory joint diseases; and he contributed to highly significant studies on toxoplasmic retinochoroiditis. Most recently he and Robert Weinreb, M.D., showed the importance of angiotensin converting enzyme in the diagnosis of sarcoid uveitis. He was the developer of a flexible metal spatula for the performance of diagnostic scrapings of the conjunctival epithelium, and this instrument still bears his name. He was a member of many scientific societies including the Association for Research in Vision and Ophthalmology