The 2011 American Academy of Ophthalmology Annual Meeting recently was recently held in Orlando, Florida. This year’s meeting was well attended and there was much excitement about a variety of new technologies for anterior segment. Here’s a brief summary of this year’s most talked about topics:
Femtosecond laser systems for cataract surgery: As one of the hottest topics in ophthalmology over the past two years, it is no surprise that these devices generated the most excitement at this year’s meeting. The existing devices from Alcon (LenSx laser), OptiMedica (Catalys Precision Laser System), and LensAR/Topcon were on display in the exhibit hall, and these were joined by the much anticipated debut of the system from Bausch and Lomb/Tecnolas (Victus)—a laser system that can perform all the lens and cornea cuts for cataract surgery as well as create corneal cuts for LASIK flaps and keratoplasty. There were numerous papers presented on this technology:
- Dr. Stephen Slade reported a 70% reduction in preoperative cylinder in 30 eyes treated with laser astigmatic incisions.
- Dr. Jonathan Talamo discussed how the patient interface design can affect the laser treatment. A curved contact interface induced corneal folds in 70% of the 54 treated eyes, which sometimes resulted in incomplete capsulotomies; as opposed to a noncontact liquid interface that caused no folds in 39 eyes.
- Dr. Juan Battle presented data showing that femtosecond laser capsulotomies are significantly more accurate and precise with respect to size, shape, and centration than a manual capsulorhexis.
- Dr. Warren Hill revealed the effect of laser capsulotomies on effective lens position (ELP). 81% of the laser eyes vs. 75% of the manual eyes were within 0.50 D of the intended spherical equivalent.
- Dr. William Culbertson showed that laser assisted cataract surgery reduces the phaco energy (CDE [cumulative dissipated energy]) required to emulsify the lens. In 39 laser treated eyes vs. 29 control eyes, there was a reduction in CDE of 47% for grade 1-3 nuclear cataracts and a reduction in CDE of 45% in grade 4 nuclear cataracts.
- Dr. Harvey Uy also reported a reduction in CDE when laser assisted surgery was performed in a fellow eye study of 85 patients. The mean reduction in CDE for various nuclear cataracts was 100% for grade 1, 63% for grade 2, 39% for grade 3, and 42% for grade 4.
- Dr. Zoltan Nagy found a similar reduction in CDE (34%) for laser treated patients with dense cataracts and also stated that these patients had less corneal edema and endothelial cell loss.
- Dr. Mark Packer also showed that there is less endothelial cell loss with laser assisted surgery compared to standard surgery at 3 months postoperatively.
Collagen cross-linking (CXL): With FDA trials ongoing in the US, and a wealth of experience in other countries, this treatment for corneal ectasia remains an exciting topic. In addition to stabilizing weak corneas, CXL has also been used to improve vision in combination with topography-guided PRK and to treat infectious keratitis:
- Dr. Dilraj Singh Grewel reported on the stability of keratoconus at 4 years in 98 eyes that received CXL.
- Dr. Paolo Vinciguerra similarly showed long term stability in 521 keratoconic eyes treated with CXL.
- Dr. Michelle Cho discussed the results of 412 eyes with keratoconus that underwent topography-guided PRK combined with CXL. The most common complication was delayed epithelial healing and subepithelial scarring.
- Dr. David Lin found an 83% improvement in UCVA in 12 keratoconus eyes undergoing combined topography-guided PRK and CXL. None of the eyes lost any lines of BSCVA.
- Dr. Anita Panda presented results of 6 eyes treated with CXL for unresponsive corneal ulcers. There was improvement in all cases in 48-72 hours.
intraCOR: This femtosecond laser intrastromal corneal treatment for the correction of presbyopia shows promise for plano presbyopes. In one study, all patients had improved uncorrected near vision and stable distance vision.
Phakic IOLs: This technique is an excellent alternative to laser vision correction for treating myopia. Four-year results of the Alcon AcrySof Cachet lens showed stable and predictable outcomes with minimal endothelial cell loss. This lens has also been shown to be effective in eyes with keratoconus that were previously stabilized with Intacs. Similarly, the STAAR ICL and toric ICL demonstrated efficacy in keratoconic patients.
Anti-VEGF and intravitreal steroid therapies: Many studies are evaluating the role of intravitreal medications for the treatment of a variety of retinal disorders. VEGF Trap-Eye, ranibizumab, and steroids are the agents showing the most promise for multiple indications. Results of these studies were reviewed. Specifically, VEGF Trap-Eye is effective in treating wet AMD (VIEW1 & VIEW2 studies), CRVO (COPERNICUS study), and DME (DA VINCI study). Ranibizumab reduces the progression of nonperfusion in RVO (BRAVO & CRUISE studies), and this drug dosed monthly is also beneficial for DME (READ-2, RISE, & RIDE trials). Steroid implants (i.e., dexamethasone and fluocinolone acetonide) improve BSCVA in DME.