The 2013 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting just concluded in San Francisco. The large group of international surgeons who filled the Moscone Center was excited to learn about the latest ophthalmic products and procedures. Here is my top 10 list of new technology featured at this year’s symposium:
Femtosecond lasers for cataract surgery: These devices continue to be the most widely discussed technologic advance in ophthalmology.Alcon Surgical’s LenSx laser, OptiMedica’s Catalys Precision Laser System and the LENSAR Laser System are the three systems that are fully cleared by the FDA for all lens and corneal incisions for cataract surgery. The LenSx laser also has the ability to create corneal flaps for refractive surgery. The Bausch and Lomb/Technolas VICTUS Femtosecond Laser Platform received FDA 510(k) clearance for corneal flaps, arcuate incisions, and anterior capsulotomy, but it is still awaiting approval for lens fragmentation.
Optiwave Refractive Analysis (ORA) system (WaveTec Vision): This device is the next generation of the ORange instrument and allows real time intraoperative aberrometry to guide IOL selection and astigmatic correction. The optimized algorithms allow faster and more accurate measurements for both pseudophakic and aphakic eyes to guide refractive cataract treatments. These include IOL power calculation for standard and premium IOLs, toric IOL power calculation and rotation, and LRI placement guidance. The latest feature is VerifEye, the new monitoring hardware upgrade that incorporates a faster imaging processor with double the speed. This enables VerifEye to continuously monitor refractive information of the patient’s eye ensuring more consistent and accurate measurements.
SMI SG5000 Surgery Guidance system (SMI) and Callisto eye (Carl Zeiss Meditec): These instruments improve the accuracy of surgical astigmatism correction by allowing the surgeon to capture preoperative images of the eye that are subsequently registered at the time of surgery and are displayed as an overlay during the procedure. In this way, the axis of astigmatism can precisely be identified.
Intrepid AutoSert IOL injector (Alcon): This automated IOL injector handpiece enables one-handed precisely controlled and programmable lens insertion with the INFINITI system foot pedal. This also frees the surgeon’s second hand to use another instrument. There are three parameter settings: initial velocity, pause time, and final velocity (fixed or linear) with default settings of 1.7 mm/sec, 3 seconds, and 1.7 mm/sec, respectively.
TECNIS Toric IOL (AMO): This lens recently received FDA approval and should be available to use soon. It is designed with an anterior toric aspheric surface on the Tecnis hydrdophobic acrylic 1-piece platform. The lens is available in 4 cylinder powers that correct approximately 1, 1.5, 2 and 2.75 D at the corneal plane and has excellent rotational stability (average rotation of 2.74 degrees).
IOLMaster 500 (Carl Zeiss Meditec): The improved software on this latest version of the IOLMaster results in acquisition times of up to 4 times faster than other optical devices, easier alignment and measurements are distance independent, which is particularly helpful for challenging patients who fixate poorly. The Dual Mode simultaneously captures axial length and keratometry measurements, and changing between modes is completely automatic. The composite signal evaluation increases the signal-to-noise values allowing for superior cataract penetration. The latest Haigis and Holladay 2 formulas are also included on the device.
OCT: Visante omni (Carl Zeiss Meditec) represents a complete anterior segment evaluation tool by combining anterior segment imaging (Visante OCT) and corneal topography (Atlas Corneal Topographer) in one device. The V-Trac registration system links the topography and pachymetry data to generate reliable posterior corneal topography maps.
Cirrus HD-OCT (Carl Zeiss Meditec) with software version 6.5 and the new FastTrac retinal tracking system reduces eye motion artifacts and ensures scanning at the highest resolution at the same location at each visit. The Precision FoveaFinder automatically identifies the fovea and centers the ETDRS grid to allow accurate comparison to normal values.
RTVue SD-OCT (Optovue) with the Total Cornea Power (TCP) upgrade allows measurement of the anterior, posterior, and net central cornea power. This is accomplished with the TCP scan (five pachymetry scan sets acquired in 1.6 sec with each set consisting of eight evenly distributed meridians of 5 micron resolution centered on the pupil) and is helpful for more accurate IOL calculations in post-refractive eyes.
EyePhotoDoc: This iPhone and iPad adaptor for slit lamps and operating microscopes quickly connects to the device’s ocular and is an affordable alternative to traditional slit lamp camera and operating microscope video systems. High quality images can easily be captured with a little practice.
SRSsoft EHR for Ophthalmology: SRS electronic medical record software offers flexible solutions for all types of practices and is especially suited to ophthalmology because the company built their first version software for a busy ophthalmic practice. What I find particularly attractive is a cost effective option of converting to EMR for offices that want minimal disruption to their current paper charting. The doctor’s paper note is directly scanned into the system and appears as the electronic record. There are numerous customizable tabs for organizing the patient’s electronic chart, and practice management modules with billing, scheduling and prescribing software are also available.
ECHO (Eyemaginations): This is a cloud-based platform for patient education. The system allows the ophthalmologist to send patients presentations they can then view on any device with an internet connection (i.e., computer, iPad or smartphone). Additional advantages of ECHO are automatic and immediate software updates, integration with social media, flexible subscription levels, and a large library of customizable animations.