Highlights from AAO 2010

Another successful meeting of the American Academy of Ophthalmology concluded last week in Chicago. As always, the sessions were chock-full of practical and cutting edge topics and the exhibit floor was bustling. Here’s a brief summary of this year’s most talked about new technologies:

Femtosecond lasers for cataract surgery once again created the most excitement at the meeting. The three companies (Alcon (LenSx), LensAR, and OptiMedica) that have developed image-guided lasers are preparing to have commercially available products next year. A number of presentations clearly showed that these lasers optimize the capsulotomy and thus the effective lens position. They also reduce the amount of phaco energy required to remove the cataract.

• Dr. Stephen Slade presented initial results from 50 patients receiving an accommodating IOL after surgery with the LenSx system. 92% of eyes had BCVA of 20/30 or better at postop day 1 and 100% of eyes had BCVA of 20/30 or better at 1 week after surgery. He emphasized that perfectly shaped and sized capsulorrhexes enhanced effective lens position and IOL-capsule overlap.
• Dr. Stephen Lane reported on 25 patients who had cataract surgery in one eye with OptiMedica’s device and standard surgery with a manual capsulorrhexis in the fellow eye. The study found that the laser capsulotomy size varied by 25 µm while the manual capsulorrhexis size varied by 248 µm.
• Dr. Roger Steinert discussed preliminary findings comparing 25 patients who had a laser capsulotomy with the LenSx laser to 21 patients who had a manual capsulorrhexis. At 1 month after surgery, the ELP was statistically significantly more stable in the laser capsulotomy patients.
• Dr. Harvey Uy showed study results from 153 patients undergoing lens fragmentation with the LensAR laser in which the cumulated dissipated energy was reduced by 40% compared to a control group that did not receive the laser treatment.

Surgical correction of presbyopia was also a popular topic, and several new approaches were highlighted.

• Dr. Ioannis Pallikaris reviewed the 1-year Flexivue implant (Presbia) data, which showed improved uncorrected near vision in all 15 patients from 20/50 to 20/25, but the uncorrected distance vision declined from 20/20 to 20/30.
• Dr. Daniel Durrie presented 3-year results from the AcuFocus study. This inlay uses the pinhole effect to increase depth of focus and therefore does not interfere with distance vision. In the 153 study patients, uncorrected near vision improved to 20/25 or better and uncorrected distance vision remained unchanged.
• Dr. Mike Holzer discussed the IntraCOR procedure that utilizes a femtosecond laser to cut concentric rings in the corneal stroma. 2-year data from 25 patients found improvement in near vision from 20/100 to 20/30, but distance vision was affected slightly due to a small myopic shift, so this technique may be best for slightly hyperopic presbyopes.

The 3D phenomenon is changing the way we experience movies in the theater and will soon be available for television. Similarly, for several years we have been able to perform surgery in enhanced 3D with TrueVision’s surgical system. One of the main advantages of this system is for teaching and observation since it allows others to experience the same view as the surgeon. This year, a number of surgical instruction courses utilized 3D video, and hopefully many more such courses will be offered at future meetings.

Implantable retinal chips have been under development for years, but are closer to becoming a viable option for some patients.

• Dr. Walter Wrobel presented data on a subretinal microchip (Retina Implant AG) implanted in 11 patients with retinitis pigmentosa. These patients recovered useful vision (ability to identify objects and read) and there were no significant complications from the surgery.

Radiation treatment for wet AMD is showing encouraging results. NeoVista’s MERITAGE study is evaluating epimacular brachytherapy in patients needing chronic anti-VEGF treatment.

• Dr. Pravin Dugel presented the 1-year results of 53 patients in the study, which showed stabilization of visual acuity in 79% and a reduction in the number of anti-VEGF injections required. 47% of patients had an improvement in vision and 10% gained 3 or more lines.

Anti-VEGF injections (ranibizumab) have also been evaluated for the treatment of diabetic macular edema. 1 and 2-year results from the RESTORE and READ-2 studies, respectively, demonstrated the efficacy of this treatment.

Finally, two interesting new drugs include:

• Fenretinide (ReVision Therapeutics) for dry AMD may slow the progression of geographic atrophy and reduce the risk of developing CNV.
• Taprenepag (Pfizer) is a new class of glaucoma medication (prostaglandin E2 receptor agonist) that has similar efficacy as latanaprost and has a synergistic effect when used in combination with latanaprost.