Tedi Begaj, MD
Alexis Warren, MD
The Advanced Vitreoretinal Techniques & Technology (AVTT) Symposium hosted by Dr. William Mieler in Chicago, Illinois returned for another weekend of learning and fun August 26th- 28th.
Day one was directed toward vitreoretinal, medical retina and uveitis fellows; the session opened with great discussions about difficult topics in clinical practice like leadership in ophthalmology, incorporating clinical research in your practice, and even an ethics round table. The second half of the morning was filled with educational pearls that fellows may face in their early careers. Highlights from this session include discussion of audits and contract negotiations by Dr. George Williams, tips for transitioning from fellowship to your first job by Drs. Robert Hyde and Michael Heiferman, and lessons from Dr. Carol Shields about life as a doctor, researcher, and mother.
The afternoon was filled with two interactive sessions beginning with the basics in vitrectomy fluidics by Dr. Yannek Leiderman and Dr. Peter Kaiser, culminating in a hands-on wet lab and mystery case panel for residents and fellows. The wet lab included demonstrations and practice sessions on the Bausch and Lomb Stellaris and Alcon Ngenunity heads up display. Trainees also experienced steroid injection systems including Xipere, a new suprachoroidal triamcinolone injection. Meanwhile, the case discussions kept us all on our toes with interesting cases of perifoveal exudative vascular anomalous complex, peripapillary pachychoroid syndrome, and foveal plana presented by world’s experts like Dr. Armani Fawzi, Dr. David Sarraf and Dr. Carol Shields.
Day two focused on imaging and new technologies where en face OCT, high resolution OCT and OCT-A were discussed in great detail. In addition, the first debate of the symposium featured Dr. Jennifer Lim arguing against Dr. R.V. Paul Chan (a most difficult task to do) on the future potential of retinal artificial intelligence! The speakers were exceedingly professional, and we learned a great deal about the topic.
The subsequent session focused on tumors, pediatrics and genetics. Dr. Shields presented a fantastic lecture about essential intraocular tumors that are important to know for any retinal physician.
The afternoon was filled with diabetic retinopathy treatment paradigms (most apropos after our own hyperglycemia from consuming some delicious lunch treats). Dr. Maria Berrocal highlighted videos displaying excellent surgical finesse when using 27G vitrectomy for diabetic TRDs- the delamination of planes was made easy with her 27G cutter. She also showed in-office fluid-air exchange for vitreous hemorrhage after vitrectomy as well as removing silicone oil from the anterior chamber – valuable tips for all fellows should the need arise.
The day was filled with excellent debates, all leading up the final debate between friend and foe, Dr. Mieler and Dr. Williams. Their debate on floaterectomies was friendly, educational and even comedic. Surprisingly, this battle royale ended in a stand still as the crowd was split even at 50/50!
The final day delved initially into neovascular AMD. Dr. Kaiser provided a wonderful talk about the pipeline of different drug therapeutics that encompass a multitude of targets for nAMD. Dr. Williams then discussed biosimilars and how they will influence our future retinal practice. At this time, we are awaiting to see how the biosimilars will be priced and whether they will be required as part of step therapy.
A hot debate occurred between Dr. David Sarraf and Dr. SriniVas Sadda, two imaging gurus from UCLA. The discussion was the importance and need for OCTA in the management of CNV. The speakers provided important real world examples for each part of the argument but ultimately the answer was not clear as the audience was close to 50:50. The battle continued after the final voting, underscoring the importance of the passion of the speakers! They did a fantastic job and we appreciated their excitement and devotion to retinal imaging.
The day wrapped up with some important pearls in the field of uveitis by Dr. Ann-Marie Lobo-Chan, and Dr. Pooja Bhat, and Dr. Amani Fawzi. Important clinic tools were discussed in infectious and non-infectious uveitis and Dr. Fawzi nicely explained the White Dots in an easy to remember way based on OCT. The meeting adjourned with Dr. Mieler’s last talk highlighting important pearls in the treatment of endophthalmitis.
The fellows are thankful to the meeting coordinators, staff and contributing physicians who worked hard to ensure AVTT was an outstanding meeting. Chicago is an inspiring city and it is wonderful to catch up with good friends.