As we welcome in the New Year and look ahead to new developments in medicine and ophthalmology, it is also a good time to reflect on the past year. We witnessed many advancements in 2014. Here is a summary of some of the most exciting technology:
Intraocular Lenses: IOLs that recently received CE mark are the Tecnis Symfony IOL from AMO and the IC-8 from AcuFocus. The Symfony lens is an extended-depth-of-field, wavefront-designed lens. It has an anterior aspheric surface and a posterior achromatic diffractive surface to improve image quality, enhance contrast sensitivity, provide a seamless range of focus from distance to near, and reduce visual side effects such as glare and halos. This design bridges the gap between multifocal and monofocal IOLs. The IC-8 is a small aperture IOL that uses the same pinhole principle as the AcuFocus Kamra corneal inlay to provide an extended depth of focus and greater range of clear uncorrected vision.
Another novel implant is the XtraFocus from Morcher. This is a one-piece small aperture diaphragm that also utilizes the pinhole effect. It is composed of a black acrylic material with a 1.3 mm central opening and three closed-loop haptics that provide sulcus centration. The material is opaque but transmits infrared light so OCT and SLO examination of the retina can still be performed. This device is intended to improve vision in pseudophakic patients with irregular astigmatism.
Catalys Precision Laser System from AMO upgrades: This femtosecond laser device for cataract surgery received 510(k) clearance for the upgraded cataract Operating System 3 (cOS3) and Liquid Optics Interface 12. The latest generation OS contains more than 50 improvements to increase the efficiency of the procedure. The redesigned template-based interface is more intuitive and allows more customization options to make the planning and treatment easier. Surgeons can see high-resolution streaming OCT images during the procedure. The new LOI is the smallest interface available with an inner diameter of 12.0 mm. The LOI 12 more easily fits patients with small palpebral fissures.
MIGS: There is continuing development in novel ab interno devices, including the Xen Gel stent from AqueSys, Hydrus Microstent from Ivantis, and CyPass Micro-Stent from Transcend Medical. There is also a new generation iStent from Glaukos undergoing clinical trials. Known as the iStent Inject, this punctal plug shaped device is inserted using a straight-ahead approach directly into the trabecular meshwork rather than an angled delivery method, making the implantation easier. The injector can be loaded with multiple stents to allow delivery of more than one without exiting the eye.
Topography-guided LASIK: This procedure was approved for the WaveLight Eye-Q excimer laser and Topolyzer from Alcon to treat irregular astigmatism with custom ablation guided by topography. This much anticipated procedure was delayed by more than a year since its FDA approval, but surgeons can soon expect to provide these individualized treatments based on corneal topographic irregularities.
Descemet’s Membrane Endothelial Keratoplasty (DMEK): This corneal endothelial transplant technique holds several advantages compared to DSAEK. Stripping and manipulating the DMEK graft is more difficult because of the absence of stroma, but this allows normal anatomy to be restored without an interface between the donor and recipient cornea. Benefits include better visual acuity (1-2 lines), faster visual recovery, and less induced higher order aberrations. There may also be less graft rejection with DMEK.
InflammaDry (Rapid Pathogen Screening): This technology has improved the assessment of ocular surface disease, particularly for patients undergoing cataract and refractive surgery. It is a quick, in-office, dry eye screening test to detect levels of the inflammatory marker matrix metalloproteinase 9 (MMP-9) in a small sample of a patient’s tears.
Corneal Topography and Aberrometry: Achieving excellent refractive outcomes with lens surgery requires more precise and accurate ocular measurements. Specifically, it has become increasingly important to obtain information about the posterior corneal shape and aberrations of the cornea, lens, and entire eye. A number of new devices have vastly improved our ability to do so:
- Cassini from i-Optics advances corneal topography by utilizing an LED array to more precisely measure the true magnitude and axis of astigmatism. Cassini provides information for the anterior corneal surface, posterior corneal surface, and total corneal astigmatism. Examinations include corneal topography, pupillometry, and color photography.
- iTrace from Tracey Technologies is a wavefront aberrometer and corneal topographer that accurately measures the cornea and total eye aberrations with ray tracing technology. The device provides additional information including autorefraction, keratometry, pupillometry, white-to-white measurement, and angle kappa.
- ORA System from WaveTec Vision is an intraoperative wavefront aberrometer that helps guide surgical decisions and maximize outcomes. The most recent version, VerifEye, displays streaming, real-time refractive data on the screen. This allows surgeons to determine stability and ensure more accurate measurements when calculating IOL power for aphakic correction and IOL/AK placement for astigmatism correction.
Argus II Retinal Prosthesis System from Second Sight Medical Products: The first two retinal prosthesis implants in the US were performed in January 2014 in patients with severe retinitis pigmentosa. The system is implanted on the retina in one eye. Camera glasses capture images, a computer converts the images into electrical pulses, the information is wirelessly transmitted to the implant containing an electrode array, the array emits electrical pulses that stimulate retinal cells, which send the visual information to the optic nerve and brain where it can be interpreted by the patient.
What innovations from 2014 were most exciting for you? Let us know in the comments section.