2009 was another exciting year in Ophthalmology. A number of breakthrough technologies were unveiled and a variety of
new products were launched. I asked colleagues from different subspecialties for their thoughts regarding the most significant advances this year, which appear in the "Top 5" lists below:
Top 5 Emerging Technologies
1. Femtosecond laser assisted cataract surgery: LensAR, LenSx, and OptiMedica are developing lasers to create the capsulorrhexis, cut the crystalline lens, and make corneal incisions. LenSx's device has received 510(k) clearance from the FDA for creating capsulotomies.
2. Radiation treatment for macular degeneration: NeoVista is performing US trials of its intraocular radiation delivery system for wet AMD, and Oraya is evaluating its IRay system to precisely deliver radiation via an external approach with studies underway outside the US.
3. Punctal plug drug delivery system: QLT is studying this novel strategy for dosing latanaprost in glaucoma patients. If successful, this may be a valuable approach for delivering a variety of ophthalmic medications.
4. Corneal collagen cross-linking with riboflavin (C3-R; CXL): US trials are underway to evaluate the effects this procedure has on strengthening the cornea in patients with keratoconus and corneal ectasia after laser vision correction.
5. Ocular bandages: OcuSeal (BD Ophthalmics) and I-Zip (Ocular Therapeutix) are tissue sealants with a wide range of surgical applications. These products seem promising for decreasing the risk of postoperative infection by ensuring a watertight incision.
Top 5 Devices
1. ORange (WaveTec Vision): this intraoperative wavefront aberrometer enables surgeons to more accurately correct astigmatism during surgery when using limbal relaxing incisions and toric lens implants.
2. Synchrony IOL (AMO): this dual optic IOL may be the first truly accommodating lens implant that could offer a seamless continuum of vision as opposed to the current multifocal and pseudoaccommodating lenses.
3. Tear osmolarity sytem (TearLab): this device rapidly calculates tear osmolarity to help in the diagnosis of dry eye disease.
4. PASCAL dynamic contour tonometer (Ziemer): IOP measurement with this digital contact device is not affected by corneal thickness and is therefore accurate in patients with significantly thicker or thinner than average pachymetry measurements. The slit lamp mounted instrument reads IOP as well as ocular pulse amplitude (OPA). PASCAL DCT was introduced prior to 2009, but it has become more widely used this year since OPA received a unique CPT code (0198T).
5. SD-OCT: although spectral domain (or Fourier domain) technology was introduced several years ago, it continues to evolve with new devices and software upgrades. The existing SD-OCT instruments (e.g., Cirrus (Carl Zeiss Meditec), Spectralis (Heidelberg), RTVue-100 (Optovue), and 3-D OCT-1000 (Topcon)) allow faster imaging of larger retinal areas with superb resolution. Ophthalmologists can now view pathology from new perspectives such as 3D cube scans, en face imaging, and enhanced depth imaging.
Top 5 Pharmaceuticals
1. Durezol (Sirion): preservative-free difluprednate is a potent steroid (fluorinated derivative of prednisolone) that received FDA approval last year for the treatment of inflammation and pain after ocular surgery, and recently obtained FDA approval for the treatment of anterior uveitis.
2. Zirgan (Sirion): topical ganciclovir gel for the treatment of herpes simplex keratitis specifically targets viral DNA and is therefore less toxic to the cornea than trifluridine. It also has an easier dosing regimen that should increase compliance.
3. Acuvail (Allergan): preservative-free ketorolac with twice a day dosing for the treatment of pain and inflammation following cataract surgery.
4. Besivance (Bausch & Lomb): besifloxacin is a new fluoroquinolone specifically developed for ophthalmic use. It is formulated with the delivery vehicle DuraSite, which increases the retention time on the ocular surface for less frequent dosing and enhanced drug penetration.
5. Bepreve (Ista): topical bepotastine, a non-sedating, highly selective H1-receptor antagonist for the treatment of allergic conjunctivitis, improves ocula.
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What are your top 5 products for 2009? Leave your thoughts in the Comments section below.