Once again it was time for the American Academy of Ophthalmology annual meeting, which was held in Orlando this year. The ophthalmic companies geared up to showcase new technology and products. Some of the highlights on the exhibit hall floor are listed below according to subspecialty:
Cornea/Refractive:
The TearLab Osmolarity System enables the rapid determination of tear osmolarity in the clinic to aid in the diagnosis and management of dry eye disease. The system consists of a disposable microchip, a pen, and a reader. A small aliquot of the patient’s tears (50 nanoliters) is collected from the lid margin and the osmolarity is measured in seconds.
Tissue sealants for surgical incisions are still awaiting FDA approval. Two hydrogel compounds that are being studies are OcuSeal (BD Ophthalmics) and ReSure Adherent Ocular Bandage (Ocular Therapeutix). Both are used outside the United States.
Collagen cross-linking (CXL) continues to be a hot topic. This procedure is used to strengthen corneas with ectasia (i.e., keratoconus, pellucid marginal degeneration, and keratectasia following refractive surgery). Two companies, Avedro and Topcon, are currently conducting studies to determine the efficacy and benefit of CXL with epi-on and epi-off techniques.
Several phakic intraocular lens implants are also awaiting FDA approval. These include the toric ICL (Staar Surgical), the Veriflex lens (AMO’s foldable version of the Verisyse lens), and the Acrysof CacheT (Alcon’s foldable anterior chamber phakic IOL, which does not require iridotomies because of its unique vaulted design). STAAR’s newest generation ICL, the V4c, is designed with a central port (CentraFLOW technology) to allow aqueous flow through the lens and therefore does not require iridotomies.
Surgical correction of presbyopia is another exciting area of interest, and several corneal inlays exist for this: the Kamra (AcuFocus), Flexivue Microlens (Presbia), and Vue+ (ReVision Optics).
Cataract:
Femtosecond lasers once again top the list of the most exciting development in cataract surgery. Alcon’s LenSx Laser, OptiMedica’s Catalys Precision Laser System, LensAR’s Laser System, and Bausch + Lomb/Technolas’ Victus Femtosecond Laser Platform are the four systems in use. The Victus will first be unveiled at the upcoming AAO meeting. These devices allow surgeons to create precise, customizable, and reproducible incisions in the cornea (cataract wound, side port, and relaxing incisions) and lens (capsulotomy and lens fragmentation), thus improving safety and refractive outcomes.
Advanced technology IOLs also continue to be a hot topic. A host of presbyopia correcting lenses are under investigation. Two accommodating designs that are anticipated to soon gain FDA approval are the TetraFlex (Lenstec) and Synchrony (Visiogen) lenses. To ensure the best refractive outcomes with the latest cataract surgery equipment and lens implants, it is essential to obtain the most precise measurements. Optical devices to determine preoperative biometry are the Lenstar 900 (Haag-Streit) and the IOLMaster (Zeiss). Intraoperatively, the ORange wavefront aberrometer (WaveTec Vision) assists surgeons in precise alignment of toric IOLs and corneal relaxing incisions, and can also determine aphakic IOL power calculations. There are also systems that provide overlays to aid in sizing and placement of corneal incisions and the capsulorhexis. These include the TrueVision 3D Surgical system and the SMI Surgery Guidance SG5000 system.
Glaucoma:
Minimally invasive glaucoma surgery (i.e., less invasive, safer surgical alternatives to trabeculectomy and drainage implant procedures) continues to be at the forefront of this field. Specifically, these techniques include the ab externo approaches of Ex-Press minishunt (Alcon), and canaloplasty (iScience Interventional), and the ab interno strategies of iStent (Glaukos), CyPass (Transcend Medical), DeepLight Gold micro-shunt (SOLX), and the trabectome (NeoMedicx).
Retina:
Novel approaches to AMD treatment have been the focus of much research. On the device/surgical side, radiation therapy has shown promising results for wet AMD. The two companies with such systems are NeoVista (epimacular brachytherapy system) and Oraya (stereotactic low-voltage x-ray irradiation system (IRay)).
Spectral domain OCT has become the standard for retinal specialists because of its faster imaging of larger retinal areas and exquisite resolution. Many machines are available including the Cirrus (Carl Zeiss Meditec), Spectralis (Heidelberg), RTVue-100 (Optovue), Copernicus (Reichert), and 3-D OCT-1000 (Topcon).
Optos Daytona launched at this year’s meeting. The target audience for this ultra-widefield (200 degrees) retinal imaging system is the general ophthalmologist. It is a compact, easy to use device with both color and autofluorescence modes, and it offers improved image quality as compared with previous Optos retinal screening devices.