Earlier this month, ophthalmologists from around the world gathered in San Diego for the 2015 annual meeting of the American Society of Cataract and Refractive Surgery. There were many exciting and new technologies on display. Here are some of my favorite product highlights from this year’s meeting:
Presbyopic Corneal Inlays
This technology has created a buzz for several years, and the biggest news at the ASCRS meeting came on April 17 when the FDA announced the approval of AcuFocus’ KAMRA corneal inlay for the treatment of presbyopia. The KAMRA Inlay is implanted in a central corneal pocket (created with a femtosecond laser) in a patient’s nondominant eye and relies on the pinhole effect to increase depth of field and thus near vision. The implant is a 3.8 mm diameter opaque disc with a 1.6 mm central opening and is 5 microns thick. There are 8,400 microperforations to allow nutrient flow through the implant. Other competing technologies are the Flexivue Microlens from Presbia and the Raindrop Near Vision Inlay from ReVision Optics, both of which have also demonstrated efficacy in clinical studies but are still awaiting FDA approval.
New Multifocal IOLs
New add powers are available for Alcon’s ReSTOR and Abbott’s TECNIS lenses. ReSTOR +2.50 and TECNIS Multifocal +2.75 and +2.25 are the new lenses available. The ReSTOR +2.50 lens provides approximately 1.75 D of correction at the spectacle plane to provide better vision at the intermediate distance. This complements the previous ReSTOR models with powers of +3.0 and +4.0. There are also 3 models of the TECNIS Multifocal. In addition to the ZMB00 +4.0, the new ZLB00 +3.25 and ZKB00 +2.75 provide correction at the spectacle plane of approximately 2.50 D and 2.00 D respectively. These expanded ranges of multifocal lens add powers that allow better customization of the range of clear near and intermediate vision for our patients who select presbyopia-correcting IOLs.
Extended Depth of Focus IOLs
This new class of IOL implants may be superior to the present multifocal IOLs. Rather than splitting light into multiple focal points, the extended depth of focus lenses extend the focal point over approximately 2 diopters to increase depth of focus. This is achieved by spherical and chromatic aberration on the lens. As a result, there is no loss of clarity, and the degree of induced glare/halo is similar to that of monofocal lenses. These lenses are available outside the Unites States, and specific designs include the Mplus from Oculentis, Mini WELL from Sifi MedTech, IC-8 IOL from AcuFocus, and TECNIS Symfony from Abbott.
iTrace
This device from Tracey Technologies utilizes ray tracing technology to provide essential refractive measurements for the cornea, lens, and entire eye. This is particularly helpful in determining the best surgical procedure in presbyopic patients and those who have had previous corneal refractive surgeries. The iTrace measures auto-refraction, corneal topography, ray tracing aberrometry, pupillometry, auto-keratometry, quality of vision and visual function. By utilizing both wavefront aberrometry and corneal topography, the device is able to calculate lenticular aberrations by subtracting the corneal from the total aberrations.
VERUS Ophthalmic Caliper
This device from Mile High Ophthalmics is a flexible, silicone ring that serves as a guide for sizing and centering a 5 mm capsulorhexis. It is inserted through the cataract incision, placed on the anterior capsule, and removed after the capsulorhexis is completed. This novel aid is may prove to be particularly helpful for beginning surgeons who are learning and mastering the capsulorhexis technique.
Dry Eye Omega Benefits
These re-esterified omega-3 fatty acid gel capsule supplements from Physician Recommended Nutriceuticals are beneficial for patients with dry eye disease because of their anti-inflammatory properties. The recommended dosage of 4 capsules (2 gm) once a day contains 1,680 mg EPA and 560 mg DHA. The results of a recent study performed by Dr. Eric Donnenfeld and colleagues showed that after 12 weeks on this regimen, dry eye patients had significant improvement in tear osmolarity, OSDI, tear break up time and omega index levels. An omega 3 index level above 8 has also been shown to be cardioprotective.
RoboMarker
This innovative device from Surgilum was developed by Dr. Alan Brown to accurately mark the cornea for astigmatism correction. The RoboMarker has a number of unique features including sterile tips preinked with gentian violet, a self-leveling pendular weight accurate to 1 degree, a ring dial for easy axis alignment, and an integrated fixation light with white, blinking red or multi-color options. The RoboMarker is simple to use, accurate, and the marks it creates can last for hours.
I-Ring Pupil Expander
This new product from Beaver Visitec is a polyurethane ring that gently and safely expands small pupils to 6.3-6.5 mm. Key features of this ring are hinges to enable insertion and removal without torqueing of the device, channels to stabilize the iris horizontally and vertically for 360 degrees, and four positioning holes that allow easy manipulation with a Sinskey hook. This device is an alternative to the Malyugin ring for pupillary expansion and stabilization, which is especially important in patients with IFIS in order to reduce the risk of intraoperative complications.
ReSure Sealant
This product from Ocular Therapeutix is the only FDA approved ocular sealant. It is a hydrogel polymer that is easy to apply, comfortable for the patient, and lasts for 4 to 5 days. It demonstrated superiority to a standard suture for wound closure. This is an excellent alternative for achieving watertight corneal wound closure.