The American Academy of Ophthalmology 2010 meeting in Chicago was a great venue for companies to showcase new technology and products. This year also marked the inaugural pre-academy oculofacial plastic surgery subspecialty day. Here's what I found when I surveyed ophthalmologists from different subspecialties for their opinions at this year's meeting:
Cornea:
One of the hot topics this year was collagen cross-linking (CXL) to strengthen corneas with ectasia (i.e., keratoconus, pellucid marginal degeneration, and keratectasia following refractive surgery). New anti-infective medications that are now available from Bausch + Lomb include Zirgan (ganciclovir gel for the treatment of herpes simplex keratitis is less toxic to the cornea than Viroptic because it specifically targets viral DNA and has a simpler dosing regimen) and Besivance (besifloxacin, the latest fluoroquinolone specifically developed for ophthalmic use, is the most potent fluoroquinolone and has more activity against multi-drug resistant bacteria). Tissue sealants for surgical wounds have long been an active area of research and 2 products are close to gaining approval: OcuSeal (BD Ophthalmics) and ReSure Adherent Ocular Bandage (Ocular Therapeutix). Intense pulsed light therapy for the treatment of Meibomian gland dysfunction has garnered more attention over the past year, and DermaMed is offering a course on this procedure by its developer Dr. Rolando Toyos.
Refractive:
Surgeons who implant phakic IOLs are eagerly awaiting the approval of the toric ICL (Staar Surgical), the Veriflex lens (AMO’s foldable version of the Verisyse lens), and the Acrysof CacheT (Alcon's foldable anterior chamber phakic IOL, which does not require iridotomies because of its unique vaulted design). The VuMAX II UBM (Sonomed) enables high-quality anterior segment imaging and can be particularly helpful for phakic IOL surgical planning since it allows accurate determination of the sulcus-to-sulcus measurement. For the surgical correction of presbyopia, the most promising strategy may be corneal inlays such as the Kamra (AcuFocus), Flexivue Microlens (Presbia), and Vue+ (ReVision Optics).
Cataract:
Femtosecond lasers continue to be the most exciting development in cataract surgery. LenSx (acquired by Alcon earlier this year), OptiMedica, and LensAR are the three companies developing this technology, which is targeted to be commercially available soon. The devices enable surgeons to create precise, customizable, and reproducible incisions in the cornea (cataract wound, paracenteses, and relaxing incisions) and lens (capsulotomy and lens fragmentation), thereby improving safety and visual outcomes.
Premium IOLs also remain a focus of discussion. A number of accommodating lenses are in development, and the TetraFlex (Lenstec) and Synchrony (Visiogen) are two that are awaiting FDA approval. Multifocal toric IOLs (i.e., Alcon’s toric ReSTOR lens) and an expanded range of toric IOLs (to treat > 2 D of corneal astigmatism) are already available outside the United States and will hopefully be approved for use in the US shortly. Another specialized IOL is the Implantable Miniature Telescope (VisionCare Ophthalmic Technologies) used for patients with severe macular degeneration is now FDA approved.
There are several other devices that stand out this year. The OPMI LUMERA 700 (Zeiss) microscope provides an unparalleled view of the surgical field (clarity, resolution, depth of field, and quality of the red reflex). Orange (WaveTec Vision), an intraoperative wavefront aberrometer, aids surgeons in improving alignment of toric IOLs and corneal relaxing incisions, and can also be used to determine aphakic IOL power calculations, which is extremely useful in patients with prior corneal refractive surgery. The Lenstar 9000 (Haag-Streit) is a remarkable instrument that accurately obtains all the necessary preop measurements and others. It is similar to the IOLMaster (Zeiss) but is faster and provides more data.
Glaucoma:
Less invasive, safer surgical alternatives continue to be the most exciting topic. These procedures can be categorized as ab externo (Ex-Press minishunt (Alcon), canaloplasty (iScience Interventional) or ab interno iStent (Glaukos), CyPass (Transcend Medical), DeepLight Gold micro-shunt (SOLX), trabectome (NeoMedicx).
Retina:
Research into new treatment for AMD continues to be one of the most exciting topics. Radiation is showing promising results for wet AMD with both NeoVista's surgical approach and Oraya's external method. Similarly, the Genentech trials of Lucentis for treating RVO have shown excellent outcomes. Spectral domain OCT is becoming the standard for retinal specialists with its faster imaging of larger retinal areas and superb resolution. Numerous devices are available including the Cirrus (Carl Zeiss Meditec), Spectralis (Heidelberg), RTVue-100 (Optovue), Copernicus (Reichert), and 3D OCT-2000 (Topcon).