The American Academy of Ophthalmology annual meeting returns to Chicago in October. One of the main highlights every year is the exhibit hall, which is sure to be filled with the latest ophthalmic technology. Here is a preview of some of the products I am looking forward to learning more about:
Cataract:
ReSure Sealant from Ocular Therapeutix gained FDA approval earlier this year. This tissue adhesive can now be used for sealing leaky clear corneal incisions following cataract surgery. The sealant is a synthetic polyethylene glycol hydrogel that rapidly gels in less than 30 seconds and is easy to prepare and apply, and it does not cause any discomfort. Image guided systems produce overlays in the surgical microscope to aid in specific steps of surgery (i.e., incision placement, capsulorhexis guide, steep corneal meridian). Examples of these are the CALLISTO eye from Zeiss, VERION Image Guided System from Alcon, and TrueVision 3D Surgical system from TrueVision Systems.
Femtosecond laser systems for cataract surgery remain an exciting technology that continues to generate plenty of discussion. Specifically, these devices include 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.
The LENSAR Laser System combined with TrueVision’s TrueGuide technology.
Software upgrades and hardware improvements such as Alcon’s SoftFit interface and AMO’s smaller diameter patient interface have improved both the outcomes and user experience. The companies are also integrating other advanced technologies with their lasers to further improve the refractive cataract surgical process. Alcon was the leader in this approach with the Cataract Refractive Suite that enables seamless information transfer among devices. The suite consists of the Verion image guided system, LenSx laser, Luxor LX3 microscope, and Centurion phaco machine. LensAR is collaborating with i-Optics and TrueVision 3D to allow the capture and wireless transfer of information between the Cassini Corneal Topographer, LensAR Laser System, and TrueGuide system. TrueVision 3D and Leica are also working to unite computer guidance with ophthalmic microscopes.
Intraoperative Wavefront Aberrometers have demonstrated efficacy in improving refractive results for astigmatism correction and IOL power determination, particularly in eyes with previous corneal refractive surgery. The ORA VerifEye from WaveTec Vision and the HOLOS IntraOp from Clarity Medical Systems are compact units that attach to the surgical microscope and display real-time streaming refractive measurement data throughout the surgery.
Advanced Phaco Fluidics characterizes the newest generation of phaco machines. The CENTURION Vision System from Alcon utilizes Active Fluidics to improve anterior chamber stability and maintains a target IOP by automatically monitoring and adapting to the intraocular conditions. The Stellaris Vision Enhancement System with StableChamber Fluidics from Bausch + Lomb also delivers improved fluidic control for a safer surgery.
IOL delivery has improved with preloaded and automated systems. The iSert from HOYA, Tecnis iTec from AMO, and AcrySert C from Alcon are preloaded lenses; however, they are not FDA approved. The INTREPID AutoSert injector from Alcon and the Bausch + Lomb Injector System (BLIS) represent automated IOL delivery technology. The Alcon system uses the foot pedal of the INFINITI and CENTURION phaco machines to precisely control lens insertion.
Cornea:
Collagen Cross-Linking (CXL) uses riboflavin and UV light to strengthen ectatic corneas. The VibeX/KXL System from Avedro and VEGA UV-A light system from Topcon are showing excellent results but are still awaiting FDA approval. CXL has also proven useful for the treatment of recalcitrant infectious corneal ulcers.
Dry Eye Disease and Blepharitis continue to be important and relevant topics. In office diagnostic technologies are valuable methods for making the diagnosis and monitoring treatment results. The InflammaDry Detector from Rapid Pathogen Screening measures the tear level of matrix metalloproteinase-9, a marker for inflammation, whereas the TearLab Osmolarity System from TearLab determines the patient’s tear osmolarity. i-Lid Cleanser from NovaBay is a novel lid and lash cleansing solution that contains 0.01% hypochlorous acid, which is useful for lid hygiene.
Refractive:
The AcuTarget HD provides comprehensive diagnostics.
Visian Toric ICL from Staar Surgical received an FDA panel recommendation for approval this year, so hopefully U.S. surgeons will have access to this important technology soon. However, the TICL will not have the new V4c CentraFLOW design that eliminates the need to create iridotomies.
Intracorneal inlays represent an exciting surgical treatment for the correction of presbyopia. Various implants are currently under FDA investigation, including the KAMRA from AcuFocus, Flexivue Microlens from Presbia, and Raindrop Near Vision Inlay from ReVision Optics, all of which have demonstrated efficacy.
AcuTarget HD Analyzer from Visiometrics is a diagnostic device specifically designed to optimize outcomes for corneal inlay procedures, but it is also a valuable tool for assessing any presbyopic surgical candidate. The machine measures the location of the 1st Purkinje image, objective scatter index (OSI), point spread function, and pseudoaccommodation which are predictors of quality of vision, visual acuity, and depth of focus. This data also is important for appropriate patient selection as well as evaluating the postoperative inlay position.
Glaucoma:
Minimally Invasive Glaucoma Surgery (MIGS) is the hottest area of development. Specific devices include the EX-PRESS Glaucoma Filtration Device from Alcon, iTrack 250A Canaloplasty Microcatheter from Ellex, Endolaser Cyclophotocoagulation from Endo Optiks, iStent Trabecular Micro-Bypass Stent from Glaukos, Hydrus Microstent from Ivantis, CyPass Micro-Stent from Transcend Medical, Gold micro-shunt from SOLX, and the Trabectome from NeoMedix.
Retina:
Optovue’s new iScan guides the patient through the OCT process.
Retinal imaging continues to improve with easier to use devices that quickly capture high-resolution images. The iScan from Optovue is a software-assisted OCT that features audio guides for patients to minimize operator involvement. The TRC NW400 from Topcon is a fully automated non-mydriatic retinal camera that can obtain photos of the retina as well as the anterior segment. The Eidon from Centervue is a confocal scanner that captures high quality color and infrared images from automated or manual modes. The wide field of view is 60 degrees in a single exposure and 110 degrees with multiple acquisitions, and pupillary dilation is not necessary. The EvokeDx from Konan Medical is a next generation visual evoked potential device that utilizes icVEP technology to simplify the assessment of visual pathway abnormalities. Similarly, the NOVA-VEP and NOVA-ERG from Diopsys, Inc. are automated devices that simplify visual pathway testing for both the patient and the examiner.