The 2016 American Society of Cataract and Refractive Surgery (ASCRS) annual meeting was held in New Orleans earlier this month. In addition to the numerous symposia, papers, courses, and films, the exhibit hall offered a vast array of new and exciting technologies. Some of the products at this year’s meeting that garnered the most interest were:
Corneal Collagen Cross-Linking (CXL)
There was much discussion about the Avedro KXL® System and two photoenhancers (Photrexa®0.146% and Photrexa Viscous 0.146%) that were recently approved by the FDA for corneal collagen cross-linking treatment in patients with progressive keratoconus.
The Zepto (Mynosys) is a disposable nanopulse device that creates a precision pulse 5.2 mm capsulotomy. This foldable system is placed in to the anterior chamber where it engages the lens capsule with gentle suction and creates a reproducible capsulotomy with low energy.
Next Generation Biometers
Swept-source OCT is now being incorporated in ophthalmic biometry devices. The IOLMaster® 700 (Zeiss) was the first of these new optical biometers. Compared to the previous IOLMaster instrument, the 700 model is faster, has better repeatability, uses more data points for keratometry, measures corneal and lens thickness, and provides visual verification with OCT scans.
The ARGOS (Movu) is another biometer that utilizes swept-source OCT technology. Axial length measurements obtained with the ARGOS are comparable to those from the IOLMaster 500 (Zeiss) and the Lenstar® LS 900 (Haag-Streit). In addition to axial length, the device also measures keratometry, corneal thickness, anterior chamber depth, lens thickness, white-to-white, pupil size, and has five built-in IOL calculation formulas.
Scheimpflug imaging is also able to measure axial length. The Pentacam® AXL (Oculus) integrates optical biometry into the existing Pentacam technology to provide axial length data and IOL calculations.
Extended Depth of Focus IOLs
There are a variety of IOLs that provide patients with a range of distance and near vision after cataract surgery. Multifocal IOLs have become the most frequently used presbyopia-correcting lenses; however, the newer extended depth of focus (EDF) IOLs are generating a great deal of excitement due to their superior optical design.
Examples of these IOLs are the TECNIS® Symfony (AMO), Mplus (Oculentis), MiniWell (Sifi Medtech), and IC-8 IOL (AcuFocus). EDF IOLs do not split light into multiple focal points but instead utilize spherical and chromatic aberrations to increase depth of focus. This strategy prevents the loss of clarity and induced glare and halo that typically occurs with multifocal lenses. In fact, the quality of vision with EDF IOLs is akin to that provided by monofocal lenses.
Surgical Correction of Presbyopia
The Kamra™ inlay (AcuFocus) gained FDA clearance last year for treating presbyopia. It is a tiny implant that is placed in the non-dominant eye over the visual axis within a corneal pocket created with a femtosecond laser. The patient’s improved near vision results from the pinhole effect to increase depth of field. Similar devices that are not yet FDA approved include the Flexivue Microlens™ (Presbia) and the Raindrop® Near Vision Inlay (ReVision Optics).
OCT Angiography (OCTA)
This noninvasive innovation in OCT imaging enables detailed evaluation of the retinal and choroidal circulation without the use of intravenous dye. Retina specialists throughout the world are rapidly adopting this remarkable technology. The current devices are the AngioVue™ (Optovue), AngioPlex™ (part of Cirrus™ HD-OCT; Zeiss), and as part of the Spectralis® (Heidelberg Engineering).
The SVOne (Smart Vision Labs) Enterprise and Pro are smartphone-based aberrometers that provide automated, objective refraction with mobile devices. The core technology is the same as found in the original SVOne autorefractor, but the measurement parameters have been increased (sphere range of -14 to +14 D, and cylinder range of -7 to +7 D).
Dry Eye Nutriceuticals
Omega-3 fatty acids (EPA and DHA) are anti-inflammatory agents that are beneficial for a variety of medical conditions. Dry Eye Omega Benefits® (Physician Recommended Nutriceuticals) contains re-esterified omega-3 fatty acid and has demonstrated efficacy in improving signs and symptoms (i.e., tear osmolarity, OSDI, tear break up time and omega index levels) in patients with dry eye disease.
Contact Lens-Based Monitoring
The Triggerfish® (Sensimed AG) recently received marketing clearance by the FDA. This sensor-embedded contact lens telemetry system records continuous volumetric eye measurements, which is helpful for detecting changes in ocular dimensions for monitoring patterns of IOP fluctuations. The goal is to use this data to predict glaucoma progression.