Dr. Neil Friedman takes a look back to provide his overview of the most important ophthalmology developments of 2015.
There were many exciting developments in Ophthalmology in 2015. Here are some of the new products I found to be most interesting:
Intraocular Lenses
New advanced technology lenses are the hottest topic in cataract surgery, but many of these IOLs are only available outside the US. Some of the most interesting designs include:
Acrysof IQ Panoptix trifocal from Alcon: This trifocal IOL has diffractive aspheric optics, no apodization, and allows 88% light transmission. The 4.5 mm central diffractive zone enables near, intermediate, and far vision focus.
Mini WELL Ready from Sifi Medtech: This multifocal IOL utilizes progressive optics and spherical aberration to increase depth of focus. It is a copolymer lens 10.75 mm total diameter with 4 haptics and provides good visual acuity at all distances with no glare or halo.
Scharioth Macula Lens A45SML from Medicontur: This add-on lens is a piggyback IOL with a 1.5 mm central high add power of +10 D. The lens is acrylic, 13 mm overall diameter with 4 symmetric haptics, and is placed through a 2.2 mm incision into the sulcus in patients with macular degeneration.
Small Aperture Pinhole Lens: This opaque IOL has a small central opening that works as a pinhole for patients with distorted corneas to reduce glare and aberrations. It is a piggyback lens that is placed in the sulcus. The lens allows transmission of infrared light so that the posterior segment can be imaged.
Astigmatism alignment
Surgical correction of astigmatism, whether with corneal incisions or a toric implant, requires accurate and precise measurement of the quantity and orientation of the astigmatism to ensure successful outcomes. Intraoperative aberrometry with the ORA VerifEye and Holos Intraop systems can be helpful during surgery, but there are also a number of devices that aid in this process preoperatively.
Cirle Surgical Navigation System from B+L: This system works with a surgical microscope to permit 3D surgical navigation.
VERION Image Guided System from Alcon: This technology is a component of Alcon’s cataract refractive suite. It consists of a reference unit that creates a digital blueprint of the optimized procedure for the patient, and a digital marker that displays the patient information and images at the time of surgery.
CALLISTO eye from Zeiss: This device provides astigmatism reference measurements, visualization of corneal curvature, incision placement alignment, and capsulorhexis assistance. The data is integrated into the Lumera operating microscope.
Toric Alignment by Osher from Eye Photo System: This digital mapping software created by Dr. Robert Osher identifies and displays an image of iris landmarks to precisely locate the target meridian for astigmatism correction.
Wet Field Osher ThermoDot Marker from BVI: This intraoperative cautery instrument creates an ink-free, fine spot at the corneal limbus to serve as a precise and easily visible reference point.
IOLMaster 700 from Zeiss
This updated IOLMaster integrates SWEPT source OCT to create a new generation of biometry devices. Measurements are faster and have better repeatability, keratometry uses more data points and is distance independent, corneal and lens thickness values are calculated, and measurements can now be visually verified with the OCT scans.
Zepto Precision Pulse Capsulotomy System from Mynosys
This automated device creates a precise and reproducible 5.2 mm capsulotomy using low-energy precision pulse technology. The system is comprised of a clear silicone suction cup, nitinol capsulotomy ring, incision finder, disposable handpiece, and power console. The device is inserted into the eye where it unfolds and suction is applied to the capsule. A millisecond energy pulse triggers a rapid phase transition of water molecules causing instantaneous cleavage of the capsule to produce the capsulotomy. This procedure is safe with no significant temperature rise in the eye, no zonular stress, and can be used in eyes with corneal opacity. This device does not yet have CE Mark or FDA clearance.
Small Pupil Devices
Traditionally, iris hooks have been used to enlarge small pupils at the time of cataract surgery, but now there are many other devices that serve this function.
Assia Pupil Expander from APX Ophthalmology: This device consists of two spring loaded components inserted through 1.1 mm side-port incisions and creates a 6 x 6 mm rectangular opening in the pupil.
Visitec I-Ring Pupil Expander from Beaver Visitec: This soft polyurethane device creates a 6.3 mm circular pupillary opening by engaging the iris 360 degrees. It has 4 channels that stabilize the iris both horizontally and vertically, and there are 4 positioning holes for a Sinskey hook to facilitate ring manipulation. Insertion and removal are easy and atraumatic.
Malyugin Ring 2.0 from MicroSurgical Technology: This softer, more flexible Malyugin ring is composed of 5-0 prolene and has larger scrolls. It is still available in the usual 6.25 mm and 7.0mm sizes of the original ring. The redesigned inserter allows gentle delivery through a corneal incision as small as 2 mm.
Kamra Inlay from AcuFocus
This presbyopia correcting technology garnered the most attention this year with its recent FDA approval as the newest refractive surgical product. The implant is inserted into a femtosecond laser created corneal pocket in the non-dominant eye, and it improves near vision by increasing depth of focus with the pinhole effect. The company is also investigating similar technology in its IC-8 IOL.
Portable Camera Devices
Anterior and posterior segment photography no longer requires expensive specialty cameras. There are various adapters and handheld devices that allow the examiner to capture quality images of the eye. Some of these work with smart phone cameras.
iExaminer from Welch Allyn: this product enables ocular imaging with an iPhone and works with the PanOptic ophthalmoscope.
Mobile Terry i-Slit Lamp from EyePhotoDoc: this company already manufactures slit lamp adapters for phones and iPads. This new device is a handheld slit lamp with an adapter so portable anterior segment photos can be acquired.
iNview from Volk: This iPhone fundus camera works with a free mobile application. The lens offers 1 megapixel resolution with a static 50-degree and dynamic 80-degree field of view through a minimum pupil size of 5 mm. There is an auto-capture as well as forced-capture mode and the device is compatible with the iPhone and iPod touch.
Other new products from Volk include the PictorPlus FA module for portable fluorescein angiography or at the slit lamp, and the eye check, a handheld camera-like device that provides lid, pupil, and limbus measurements that are helpful for contact lens fitting and oculoplastics evaluations.