The 2011 American Society of Cataract and Refractive Surgery meeting recently convened in San Diego, California. The convention center was bustling during the week of scientific sessions, papers, courses, and video presentations. The ballrooms and classrooms were packed with an international group of anterior segment surgeons excited to exchange ideas and discuss the latest cutting edge technology. I asked a group of ophthalmologists for their opinions on what they found most interesting at this year’s meeting and then selected the top 5 to share with you. Here is how the technologies ranked:
1. Femtosecond lasers for cataract surgery:
Once again, this incredible technology tops the list of the hottest topics in ophthalmology and was definitely the most talked about topic at this year’s meeting. The companies developing FS laser cataract devices include LenSx, LensAR, OptiMedica, and Zeiss. The lasers are integrated with imaging devices to precisely control lens and corneal incisions. They are capable of creating the anterior capsulotomy, segmenting and softening the crystalline lens, and performing the cataract, side port, and corneal relaxing incisions. LenSx, which was purchased last year by Alcon, has received 510(k) clearance from the FDA for making all of these incisions. The LensAR machine has clearance for the capsulotomy and lens fragmentation and is awaiting approval for the other cuts. OptiMedica is also expecting to receive FDA clearance later this year. There were multiple presentations from each of these companies clearly demonstrating the superiority of these lasers compared to manual techniques.
2. Carl Zeiss IOL Master 500:
Since the advent of the IOLMaster, this technology has become the preferred method for performing preoperative cataract surgery measurements and calculations in many surgical practices. The ease of use and precision of this instrument makes it a favorite among cataract surgeons as well as the technicians who usually operate it. The new version of the IOLMaster, the 500, is faster and has improved penetration to enable accurate readings in very dense cataracts. It has a dual measuring mode that captures axial length and keratometry measurements at the same time, and changing from mode to mode is automatic. The IOLMaster 500 also automatically selects the appropriate IOL calculation formulas for the patient’s axial length.
3. TearLab Osmolarity System:
This device rapidly calculates tear osmolarity to aid practitioners in the diagnosis and management of dry eye disease. It is the first objective and quantitative test of its kind. The system is composed of 3 parts: a disposable microchip, a pen, and a reader. A tiny sample of tear film (50 nanoliters) is easily collected from the patient’s lid margin and then analyzed in seconds to determine whether increased osmolarity is present. This data can be helpful in early/mild cases of dry eye disease in which the patient may have few if any signs and symptoms. In addition, this test is useful for monitoring the efficacy of treatment and documenting an improvement in tear film osmolarity.
4. Ellex Eye Cubed UBM:
A new diagnostic UBM mode (40 MHz) is being introduced to the Eye Cubed ultrasound device, which will improve the resolution of anterior segment structures to provide highly detailed images. The main advantage of ultrasound over other imaging technologies (i.e., OCT) is that ultrasound can be performed through opaque ocular media. This allows a wider range of pathology to be imaged. UBM has also been demonstrated to be the most accurate method of sizing the sulcus, which is critical for implanting lenses in this location.
5. (Tie) Reichert Ocular Response Analyzer Software 3.01:
The updated software for the ORA improves the entire measurement process. The new software is faster and more user-friendly than earlier versions, and it automatically detects the most reliable corneal hysteresis measurement. In addition, this version of software can better identify keratoconus. This is accomplished by waveform analysis and two new indices (keratoconus match index (KMI) and keratoconus match probability (KMP)) that are used to compare the patient’s measurement signal to a normative database and thereby determine the presence and degree of keratoconus.
5. (Tie) Oculus Pentacam HR Premium:
The Pentacam device has been upgraded and now comes with a 27" iMac and connectivity to an iPad for easier access to and review of the exam results. The HR Premium also has a new iris/pupil camera and improved software to allow the following data displays: overview of all Scheimpflug images, comparing and matching Scheimpflug images, total corneal power, and power distribution. There is also an enhanced pIOL database.