The annual meeting of the American Academy of Ophthalmology is rapidly approaching. Physicians from around the globe will be descending on New Orleans for this year’s event, and the exhibit hall is always one of the main attractions. Exciting technology and new products that will be featured are as follows:
Cornea:
Tissue sealants are currently used outside the United States for closure of corneal, conjunctival, and scleral wounds, and have long been awaiting FDA approval. Two hydrogel compounds being evaluated in trials are OcuSeal from BD Ophthalmics and ReSure Sealant from Ocular Therapeutix. The latter recently received an approval recommendation by the FDA Ophthalmic Device Panel for sealing clear corneal cataract incisions that are Seidel positive.
Collagen cross-linking (CXL), the procedure to strengthen ectatic corneas with riboflavin and UV light, remains the standard treatment outside the United States where it also is effective in treating infectious corneal ulcers. The FDA trials have shown promising results, but these devices such as Avedro’s VibeX/KXL System and Topcon’s VEGA UV-A Illumination System are still awaiting approval.
Dry eye disease has garnered much attention over the last several years. The LipiFlow Thermal Pulsation System from TearScience for the diagnosis and treatment of evaporative dry eye disease caused by Meibomian gland dysfunction is becoming increasingly more popular. A new improvement to the system is the updated 2.0 software for the LipiView diagnostic device to better measure blinking and identify lipid layer deficiencies. Two other office-based diagnostic technologies for dry eye disease are the RPS InflammaDry Detector from Rapid Pathogen Screening to measure levels of matrix metalloproteinase-9, which is a marker for inflammation, and the TearLab Osmolarity System to analyze the osmolarity of a patient’s tears.
Refractive:
Phakic intraocular lenses have not changed in the United States for years despite new and improved designs such as the toric ICL and CentraFLOW ICL from Staar Surgical, which are routinely implanted around the world. The AcrySof Cachet from Alcon and the Veriflex lens from AMO are anterior chamber lenses that are also awaiting FDA approval.
Intracorneal inlays are another technology US surgeons are eagerly awaiting. The KAMRA inlay form AcuFocus, Flexivue Microlens from Presbia, and Vue+ from ReVision Optics have all demonstrated efficacy in clinical studies.
Cataract:
Laser cataract surgery continues to be the most talked about topic among cataract surgeons. The systems approved in the United States are the LenSx Laser from Alcon, Catalys Precision Laser System from AMO/OptiMedica, LensAR Laser System from LensAR, and Victus Femtosecond Laser Platform from Bausch + Lomb/Technolas. Support for this technology has increased dramatically, and more and more procedures are being performed with this method. Improvements to the systems include the SoftFit Patient Interface from Alcon to reduce corneal folds and the soon to be available smaller diameter interface from AMO/OptiMedica for patients with narrow palpebral fissures.
Phaco machines have become extremely advanced. The Centurion Vision System from Alcon is a newly designed platform to optimize cataract surgery. It has Active Fluidics that improve chamber stability and maintain a target IOP by automatically monitoring and adapting to the intraocular conditions.
IOL delivery systems continue to evolve. Preloaded systems include the iSert from Hoya, Tecnis iTec from AMO, and AcrySert C from Alcon, but are not yet available in the United States. The Intrepid AutoSert IOL Injector from Alcon is an automated system controlled with the foot pedal of the Infiniti and Centurion phaco machines.
Toric IOLs remain the preference of most surgeons for correcting astigmatism at the time of cataract surgery. Although we are still awaiting the approval of toric multifocal IOLs, two toric lens that have received FDA approval this year are the Tecnis toric from AMO and TRULIGN from B+L which is a toric version of the Crystalens.
Intraoperative wavefront aberrometers include the ORA System from WaveTec Vision and Holos from Clarity Medical Systems. These devices measure the refractive status of the eye in real time and help surgeons to more accurately treat and manage astigmatism.
Image guided systems integrate with the surgical microscope and provide overlays to assist surgeons in various steps of the surgery such as incision placement, capsulorhexis guide and astigmatic axis. These include the CALLISTO eye from Zeiss, VERION Image Guided System from Alcon, and TrueVision 3D Surgical System from TrueVision Systems.
Glaucoma:
Minimally invasive glaucoma surgery is gaining in popularity. Specific technologies are the Ex-Press Mini Glaucoma Shunt from Alcon, canaloplasty from iScience Interventional, iStent from Glaukos, CyPass Micro-Stent from Transcend Medical, DeepLight Gold micro-shunt from SOLX, and the Trabectome from NeoMedicx.
Retina:
Wet AMD treatment remains at the forefront of retinal research. The IRay device from Oraya Therapeutics is a stereotactic low-voltage x-ray irradiation system that has shown promising results. The latest intravitreal medication to gain FDA approval for wet AMD is Eylea from Regeneron, which also is approved for treating macular edema following central retinal vein occlusion. Another intravitreal injectable medication called Jetrea from ThromboGenics is indicated for treating symptomatic vitreomacular adhesion.
Pattern scanning laser technology has a significant advantage over traditional retinal lasers. The PASCAL Streamline from Topcon also is available in the new PASCAL Synthesis, which has expanded macular grid patterns, choice of green (532nm) or yellow (577nm) wavelengths, and compatibility with Topcon and Haag-Streit slit lamps.
Retinal imaging has been simplified with the 200Tx from Optos, which is an ultra-widefield digital retinal imaging system that provides an image of more than 200 degrees in a single capture. It also offers improved image quality, angiographic, and autofluorescence capabilities. These are just some of the many exciting products that are changing our industry which will be on display in the AAO exhibit hall.