The annual meeting of the American Academy of Ophthalmology soon will reconvene in Las Vegas. This meeting is always a very busy event filled with wonderful courses, papers, special sessions, and other various activities. One of the most exciting highlights each year is the exhibit hall, which is an overwhelming experience even to the seasoned attendee.
Here is a preview of interesting products and technologies that will be on display:
Cataract:
Integrated advanced technology surgical systems have become the strategy for ophthalmic companies to combine their diagnostic and surgical devices into a complete package to improve the refractive cataract surgical process.
Alcon started this approach with their Cataract Refractive Suite—VERION Image Guided System, LenSx Laser, LuxOR LX3 microscope, and CENTURION Vision System—which connects these devices so they can share information.
LensAR is creating a similar system utilizing the Cassini Corneal Shape Analyzer, LensAR laser system, and TrueGuide system.
Other image-guided systems such as the CALLISTO eye from Zeiss and the TrueVision 3D Surgical system from TrueVision Systems produce overlays in the surgical microscope to aid in specific steps of surgery. Intraoperative wavefront aberrometers such as the ORA System with VerifEye+ Technology from Alcon and the HOLOS IntraOp from Clarity Medical Systems provide real-time refractive data to improve refractive outcomes. These systems may soon find partners for integration.
Verus Ophthalmic Caliper from Mile High Ophthalmics is a silicone ring which is used as a guide to size and center a round 5 mm capsulorhexis. This flexible device is easily inserted and removed through the cataract incision.
Multifocal IOLs are now available in expanded range of add powers to enable improved customization of near and intermediate focus for patients choosing these implants. Specifically, the AcrySof IQ ReSTOR +2.50 lens has ~1.75 D of correction at the spectacle plane, and the Tecnis ZLB00 +3.25 and ZKB00 +2.75, which have ~2.50 D and ~2.00 D at the spectacle plane, respectively are now available.
Refractive:
KAMRA Inlay from AcuFocus is the most exciting new refractive technology since it received FDA approval this year. This intracorneal implant is placed in a patient’s non-dominant eye to correct presbyopia. Certification courses are in full swing, and refractive surgeons are gearing up to offer this novel procedure to their patients. Other implants that are still under investigation are the Flexivue Microlens from Presbia and the Raindrop Near Vision Inlay from ReVision Optics.
FEMTO LDV Z8 from Ziemer Ophthalmic Systems is the newest generation laser system in the FEMTO LDV line, and was just granted 510(k) clearance from the FDA. It is a mobile all-in-one-device designed for a variety of cornea, refractive, and cataract procedures. Specifically, it can be used for lamellar keratoplasty, penetrating keratoplasty, intracorneal rings, intrastromal pockets, Z-Lasik, Z-Lasik Z, clear corneal and arcuate incisions, anterior capsulotomy, and lens fragmentation.
Visian Toric ICL from Staar Surgical is not yet approved by the FDA but is available in other parts of the world. The TICL allows better refractive outcomes for ICL patients with visually significant astigmatism. This is an encouraging sign that approval of the newer generation V4c CentraFLOW ICL, which eliminates the need to create iridotomies, is not far behind.
iTrace from Tracey Technologies is a unique diagnostic device combining corneal topography and wavefront aberrometry by using forward ray tracing technology. This instrument measures and separately quantitates corneal and lenticular aberrations so the doctor can distinguish between them. Additional features include measurement of refraction, keratometry, accommodation, pupil size, angle alpha (distance between the visual axis and the center of the limbus), and angle kappa (distance between the visual axis and the center of the pupil), dysfunctional lens index (objective metric for determining lens performance), and toric IOL planning software.
Cornea:
Collagen cross-linking (CXL) is the technique to photochemically strengthen the cornea by applying riboflavin to an ectatic cornea and then exposing it to UV light. Two systems currently under FDA investigation, the VibeX/KXL System from Avedro and VEGA UV-A light system from Topcon have produced promising results over the past few years. Another important application of CXL is for treating infectious corneal ulcers not responsive to traditional antimicrobial therapy.
Dry eye disease and blepharitis are common disorders that must be diagnosed and treated early, and managed effectively, especially prior to cataract and refractive procedures. New diagnostic tests and products have made this process much easier for both the physician and patient. The Osmolarity System from TearLab quickly allows measurement of tear osmolarity, aiding in both the diagnosis and management of dry eye. InflammaDry from Rapid Pathogen Screening is another simple in-office test to determine the tear level of matrix metalloproteinase-9, an inflammatory marker associated with dry eye.
Avenova from NovaBay is a hypochlorous acid (0.01%) based cleanser for the eyelids and lashes that is very effective and well tolerated in patients with anterior and posterior lid margin disease. BlephEx is a new device that works as a mechanical lid scrubber to facilitate the removal of lid and lash debris associated with blepharitis. The instrument consists of a handpiece and spinning disposable micro-sponge, which is applied to the patient’s eyelids. Dry Eye Omega Benefits from Physician Recommended Nutriceuticals are re-esterified omega-3 fatty acid gel capsule supplements that contain 1680 mg EPA and 560 mg DHA. This is the only such product that has demonstrated clinically efficacy in a well-controlled, multicenter study of dry eye patients.
Glaucoma:
Minimally invasive glaucoma surgery (MIGS) continues to have a significant impact in this field. The FDA approved devices are the iStent from Glaukos, Ex-Press mini shunt from Alcon, and the Trabectome from NeoMedix. Other exciting technologies that are currently being evaluated include the iStent inject and iStent supra from Glaukos, CyPass stent from Transcend Medical, Hydrus microstent from Ivantis, Gold micro-shunt from SOLX, Xen Gel stent from AqueSys, and the iTRACK 250A microcatheter from Ellex.
NOVA-VEP and NOVA-ERG from Diopsys, Inc. are electrophysiologic tests made simple. The Diopsys device is an automated electrophysiologic testing machine that allows easy in-office testing and interpretation of VEP and ERG tests. This has shown to be useful not only for early detection and progression of glaucoma but also for the diagnosis of a variety of other retinal and visual pathway disorders.
Rho-kinase (ROCK) inhibitors are being evaluated in studies as a new class of medication to treat glaucoma. These drugs have a triple mechanism of action: increased trabecular meshwork outflow, reduced episcleral venous pressure, and decreased fluid production in the eye. They may also have neuroprotective effects including better blood flow to the optic nerve and protecting ganglion cells. One such drug, Rhopressa from Aerie Pharmaceuticals, is in phase 3 trials.
Retina:
Retinal imaging devices have become more user friendly and allow the rapid acquisition of high-resolution scans and photos. The TRC-NW400 from Topcon is a simple to use, fully automatic, non-mydriatic retinal camera that captures both posterior segment and anterior segment pictures. Other technology includes the Eidon from CenterVue, a non-mydriatic confocal scanning device with automatic and manual modes to obtain both color and infrared images and wide fields of view (60 degrees and 110 degrees for single and multiple exposures, respectively), and the iScan from Optovue, an automated OCT with audio prompts to aid with the patient experience.