The American Academy of Ophthalmology (AAO) annual meeting will take place next week in Chicago. As the largest and most popular ophthalmology meeting, it is packed with so many interesting courses, papers, symposia, and other activities that it is easy to miss some of the new technologies being presented. Therefore, here is a sneak peak of some of the novel products to keep an eye out for.
Capsulotomy
A variety of new devices are aimed at improving the ease, precision, and reproducibility of creating the continuous curvilinear capsulorhexis. Lower cost alternatives to femtosecond laser systems include the following:
- Verus Ophthalmic Caliper (Mile High Ophthalmics) is a simple, affordable guide for sizing and centering a 5 mm capsulorhexis. It is a flexible silicone ring that is placed on the anterior lens capsule to guide the circular tear, and it is easily inserted and extracted through a small corneal cataract incision.
- Zepto (Mynosys) is a cost-effective, disposable nanopulse device that creates precise capsulotomies. It uses a silicone suction cup, nitinol cutting element, and precision pulse technology to create a phase transition in water molecules that cuts the capsule creating a 5.2 mm round opening in 4 milliseconds. It fits through a 2.2 mm incision.
- ApertureCTC™ (International Biomedical Devices) is another system that makes a continuous thermal capsulotomy but with a retractable ring filament. This device is less bulky and is composed of a disposable tip that fits through a 1.8 mm incision, and capsulotomies of various sizes (4.5 to 6.5 mm in 0.5 mm steps) can be created in milliseconds depending on the ring size chosen.
- CAPSULaser™ (Excellens) is a thermal microscope mounted laser that can achieve the same precision as a femtosecond laser. The orange laser interacts with blue-stained tissue and therefore requires trypan blue for capsular staining. After a handheld contact lens is placed on the cornea to stabilize the eye, the laser emits a continuous circular pattern to cut the capsule in a second. Prior to initiating the capsulotomy, residual trypan blue must be thoroughly washed from the cornea and iris to prevent damage to these structures.
Capsulotomies made with the above-mentioned thermal systems have increased strength compared to those created manually or with a femtosecond laser, and there is no pupil constriction.
Presbyopia Correction
IOLs: The most exciting intraocular lens (IOL) news is the recent approval of the Tecnis Symfony® (Abbott) lens. This represents a new category of lens implants: Extended Depth of Focus (EDF) — IOLs that take advantage of spherical and chromatic aberration to increase the depth of focus rather than splitting light into multiple points of focus.
The Symfony lens uses chromatic aberration to create a broader range of vision without reducing contrast sensitivity or producing glare and halos. The Symfony platform also comes in toric models that also correct for corneal astigmatism. The superior optical design of these lenses creates the same quality of vision as that provided by monofocal IOLs.
Other EDF lenses available outside the United States include the Mplus (Oculentis) and MiniWell (SIFI Medtech).
Intracorneal implants: Both the KAMRA™ inlay (AcuFocus) and the Raindrop® Near Vision Inlay (ReVision Optics) are FDA approved for the correction of presbyopia. The devices are inserted into a patient’s non-dominant eye to provide clearer reading vision. The Kamra utilizes the pinhole effect to increase depth of field, while the Raindrop creates a multifocal cornea by steepening the center.
The Flexivue Microlens™ (Presbia) in still awaiting clearance.
Laser Vision Correction
VisuMax® Femtosecond Laser (Carl Zeiss Meditec) is now FDA approved for the small incision lenticule extraction (SMILE) procedure. The laser cuts a small central stromal disc that is dissected and removed through a keyhole incision to reshape the cornea and correct for myopia in patients 22 years of age or older.
Collagen Cross-Linking (CXL)
This procedure is used to treat patients with progressive keratoconus and has undergone a lengthy FDA investigation process. The KXL® System (Avedro) with its riboflavin solution Photrexa® or Photrexa® Viscous has now received clearance in the U.S.
Photo courtesy AAO
Dry Eye
Oculeve Intranasal Tear Neurostimulator (Allergan) is a small handheld device that delivers gentle electric stimulation to the nasal mucosa increasing tear production in patients with dry eye disease. The device was granted CE Mark in 2014 and is awaiting FDA clearance.
Xiidra™ (Shire) is a new anti-inflammatory topical medication (lifitegrast) for the treatment of dry eye. The drug is an integrin antagonist that inhibits T-cell mediated inflammation by blocking the binding of two important cell surface proteins. Specifically, lifitegrast binds to lymphocyte function-associated antigen-1 (LFA-1; a T-cell surface receptor) thereby preventing LFA-1 from binding to intercellular adhesion molecule-1 (ICAM-1; expressed in corneal and conjunctival tissue).
Glaucoma
Minimally invasive glaucoma surgery (MIGS): The CyPass® Micro-Stent (Alcon) recently received FDA clearance for treating patients with mild to moderate primary open-angle glaucoma at the time of cataract surgery. In the group of study patients receiving the device, 73 percent had an IOP reduction of at least 20 percent.
Rho-kinase (ROCK) inhibitors: Rhopressa™ (Aerie) represents a new class of glaucoma medication that has a triple mechanism of action to lower intraocular pressure (i.e, increasing trabecular meshwork outflow, reducing episcleral venous pressure, and decreasing aqueous production). ROCK inhibitors may also be neuroprotective, improving optic nerve blood flow and protecting ganglion cells.
Retina
The MapcatSF (Guardion Health Sciences) device is a heterochromatic flicker photometer that measures macular pigment optical density (MPOD) using a patented Troxler-free, single fixation technique under photopic conditions. The macular pigment, which consists of three diet-derived carotenoids (lutein, zeaxanthin, and mesozeaxanthin), protects this region of the retina from high-energy light and oxidative stress. A healthy macular pigment has also been shown to reduce chromatic aberration and glare, increase contrast sensitivity, and improve photo-stress recovery.
Lumega-Z® is Guardion’s medical food, which contains all three of the macular carotenoids, to restore and maintain the macular pigment in patients with a low MPOD measurement.
The 2016 annual meeting of the American Academy of Ophthalmology (AAO) will take place October 15-18, 2016, at McCormick Place in Chicago.