No Such Thing as a Free Lunch

Congratulations on receiving the Binkhorst Medal at the 2021 ESCRS! Your lecture, titled “There is no free lunch in optics,” was one of the highlights of this year’s event. Was this also a highlight of your career?

Being able to deliver this lecture was certainly one of my biggest achievements. Within it, I tried to include much of the knowledge I have accumulated, in a way that non-specialists would understand, and I think that a good number of patients could make use of it. In general, I think I’m quite good at making complicated subjects easier to understand! It seems like the title – an idiom – was the least comprehensible element of the presentation for many people.

Over the years, there have been many events that I could call my highlights, from qualifying for medical school, to my travels to Africa. I also don’t exclusively consider my professional career to be the source of these highlights – I hugely value the achievements in my personal life. Being able to spend time with my grandchildren is a great highlight. Of course, without the support of my family, my professional career would not be what it is now. My wife has supported me through all my pursuits, and has been there to celebrate my successes, but also helped me get through tougher times.

How did you find this year’s ESCRS Congress?

I was very impressed that the committee managed to organize the meeting in such difficult times, and get so many people together in what resembled normality. These days, I usually come to events in search of new ideas, often from start-up companies, and I was able to organize some of those key meetings in Amsterdam. There are certainly really interesting new products and technologies – such as the artificial cornea – in the pipeline, and I’m looking forward to seeing them fully developed.

The main ESCRS auditorium attracted a very decent crowd, and I was very happy with attendance of my Binkhorst lecture. The audiences did not seem any smaller than usual.
 

Do you think people will still travel to events in the future or will they choose to attend conferences virtually?

Well-organized virtual meetings, like the latest ESCRS, are great for those who don’t have the option of attending events in person. Travel is often prohibitively expensive and it has been severely restricted in the last couple of years, so virtual options are welcome by many people for whom this is a chance to join more ophthalmic gatherings. Nevertheless, there are many people who still prefer to attend conferences in person. Humans learn best by interacting directly with others, and long may it continue!

How has ESCRS Congress changed over the years you have attended?

It has been growing bigger and bigger, becoming more important year on year. The organizers’ confidence has been growing, and with the increase in size of the conference and exhibition, attendee numbers have also grown, and so has the number of Society members. ESCRS itself is now a huge enterprise, with big annual turnovers. It has lost its purely scientific character and naivety of the early days, and it is now a huge professional body, with great impact and influence. When I first came to the ESCRS Congress, I was still a student, and I don’t think I have missed any meetings since then.

How has your field changed in the course of your career?

This question makes me acutely aware of my age because the change has been so dramatic! The first time I watched cataract surgery being performed, the surgeon did not wear gloves, and they used regular magnifying glasses, and then gave the patient a pair of aphakic spectacles. In Germany, phaco became the main way of performing cataract surgery at the end of the 1990s, and before that, extracapsular or intracapsular extractions were the norm. What modern surgeons often take for granted, was really out of the ordinary 30 years ago. Then, nobody would believe in cataract surgery under topical anesthesia, using foldable lenses. Excimer lasers were not commonly used in ophthalmology then, either. I have witnessed all these developments myself, over the years!

Nowadays, in the cataract and refractive field, improvements come in smaller steps; it’s more a question of fine-tuning existing technologies. There are some technologies that have the capability of changing the way ophthalmologists work more drastically, such as artificial intelligence or gene and genetic therapies. New diagnostic solutions, such as OCT, have made a lot of things possible that we couldn’t even imagine before. Nevertheless, I can’t see anyone coming up with a new piece of equipment that will drastically change my work in the next two or three years… But in 10 years’ time? Everything is possible.

IOL materials are getting better and better all the time, with new materials entering the market. Developing a new material is not the biggest issue – the main problem are regulatory hurdles that it takes many years and huge amounts of money to get through before a new material is approved. If an IOL manufacturer wants to make changes to their material, they need approval for each individual lens they offer in each country or territory with a regulatory process. With a completely new material, the process has to be started from scratch, with new clinical trials, checking biocompatibility and other features. New regulatory guidelines and recommendations are being added all the time, so it’s a never-ending story of obtaining approvals. Of course, I completely understand the need for standardization and transparency, especially in the face of many scandals that happened in the medical field in the last several decades.

What has the pandemic been like for you?

It has been difficult running a hospital over the past few months. I have to keep track of personnel’s and patients’ vaccination status and test results – it requires a lot of additional work and planning. Earlier lockdowns gave me a chance to reconsider my private life and take better care of myself – I had time to do a lot more sporting activities and I lost a lot of weight, so I have been saying that this virus has really saved my life in this way! On the other hand, it was very painful not to be around my children and grandchildren.

Do you have any advice to ophthalmologists starting their careers now?

It’s a different world compared with the one I entered 30 years ago, so I would struggle to tell young people what to do. One great piece of universal advice is to be kind to others. Remember that to most people things don’t come fast and free; if you want something, you need to work hard for it, and endure some hardships along the way. Indeed, there is no such thing as a free lunch, in optics, and in life!