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An Academy tech recap, through our KOLs’ eyes

Ophthalmology Management asked editorial board members to highlight some of the unique product offerings and services at AAO 2017. The responses, listed alphabetically by company, are below.

Some editorial board members chose the Alcon Wavelight excimer laser. “The virtual reality demo at the Alcon booth was novel, and I was impressed by the Ex500 series Wavelight excimer,” says Steven Silverstein, MD. “I plan to get one in the near future.”

Also from Alcon: The UltraSert preloaded intraocular lens delivery system with the AcrySof IQ aspheric monofocal IOL for patients undergoing cataract surgery. The surgeon can deliver an untouched IOL directly into the eye of cataract surgery patients in less time.

Alcon Wavelight

The new design features a longer 3-mm nozzle tip with a proprietary depth guard for incisions down to 2.2 mm.

“I [saw] three surgical devices that are disruptive,” says Eric Donnenfeld, MD. One is A.R.C. Laser’s Cetus for cataract surgery. The nano-laser delivers 100% photofragmentation, 100% no ultrasound and 100% single-use handpieces, according to the company. (His other picks are Zeiss’ Veracity platform and Mynosys’ Zepto, both to follow.)

Flicker ERG (Diopsys), a handheld stimulus mini-Ganzfeld device, was Mitchell A. Jackson, MD’s choice. The Flicker’s primary use is to view the retina of patients with dense cataracts. The Flicker makes viewing possible because the light flashes at 30 Hz or more; since rod photoreceptor cells cannot follow such a fast light, the cone response can be captured. Reproducibility is also verified for accuracy of response, he says.

EyeGate’s iontophoresis technology is a fascinating potential entry into the drug delivery space, says Dr. Silverstein. This system uses trans-scleral iontophoresis to deliver medications into the targeted tissues. At the OIS Summit, CEO Steven From announced enrollment of 100 patients in a phase 2 study for the treatment of inflammation and pain after cataract surgery.

Alcon UltraSert

Another Dr. Jackson pick: Lensar’s Streamline IV astigmatism guidance system for astigmatism management in conjunction with the Lensar femtosecond laser for cataract surgery. Five preoperative diagnostic machines can now use imaging via iris registration to map astigmatic incision placement or astigmatic markings in the cornea (IntelliAxis-C) or on the lens anterior capsule (IntelliAxis-L).

The five: Oculus’ Pentacam AXL and Pentacam HR; the Cassini total corneal astigmatism (i-Optics), Marco/Nidek OPD-Scan III and Topcon Aladdin biometer.

What caught Marguerite McDonald, MD’s attention was LumiThera’s treatments for dry AMD. “Multi-wavelength photobiomodulation has shown promising results in a 30-patient pilot study at three months posttreatment [the LIGHTSITE I trial],” she says.

MDBackline’s eponymous technology, which was chosen by at least three editorial board members, is an automated cloud-based care system that contacts patients after their office visits or surgeries to check on their results and satisfaction level. The software enables practices to collect data and learn lessons about what works and what doesn’t while helping the practice to keep patients happy. Institutional review boards’ and clinical research organizations’ technology can work with this software.

MDbackline “works in the background as an add-on to EHR,” in the words of developer John A. Hovanesian, MD, enabling the practice to deliver patient education material and reduce chair time.

As for Nathan Radcliffe, MD, “The most exciting thing was that we finally have all of the micro stents [approved] for glaucoma: iStent, CyPass, Xen. We have so many different ways of treating glaucoma, at times it’s tough to know which to use. This is a good problem to have for people who haven’t had many options in years past, but now we have more work to do in terms of learning about which technology to use when.”

Michael Patterson, MD says, “I am probably most impressed with the miLoop device [IanTech, Inc.].  I perform a lot of mission work in foreign countries. While I think it might not be as advantageous for the U.S. surgeons, as most of our patients come in well before cataracts mature, in foreign lands this isn’t the case. I think this device could become very disruptive.”

According to the company, miLoop is designed to achieve full-thickness fragmentation of the nucleus independent of phacoemulsification energy using a super-elastic thin filament. It is engineered to minimize capsular stress by using centripetal, out-in nucleus disassembly while conventional techniques employ centrifugal, in-out lens cutting with adjunct phaco energy. miLoop fragmentation is done under full viscoelastic chamber stability and protection and no simultaneous irrigation and aspiration.

Mynosys’ Zepto precision pulse capsulotomy device automates the capsulorhexis procedure. The Zepto has a disposable round silicone suction cup with an elastic nitinol ring that sends nonthermal electrical waveform pulses to the anterior capsule for 360 degrees. This action causes a rapid phase transition of all trapped watermecules and leads to the capsulotomy effect. A few editorial board members remarked on Zepto’s capabilities.

miLoop (IanTech, Inc.)

Other technologies of note

Besides the LumiThera technology, Marguerite B. McDonald, MD also found the Epi-Bowman’s Keratectomy (EBK) for advanced surface ablation interesting; it rivals LASIK in terms of postop comfort and the speed at which patient vision returns.

And Nathan Radcliffe, MD, was pleased to learn that an existing technology is finally getting its due. “I heard a lot about it at Academy; it’s not a new technology, but finally people are starting to use it: corneal hysteresis. Based on perspective trials, we now know that this parameter is the best predictor of glaucoma progression for either visual field deterioration or deterioration of the optic nerve. So it’s nice to see a good technology being scientifically validated, and then see people starting to adopt its use and recognize its position in caring for glaucoma patients.”

Nicox’s Zerviate (cetirizine ophthalmic solution) 0.24%, licensed to Eyevance Pharmaceuticals LLC for commercialization in the United States, is the first ocular formulation of the antihistamine cetirizine approved for treatment of ocular itching associated with allergic conjunctivitis. Eyevance plans on launching Zerviate in late 2018 to coincide with the fall allergy season.

OCULUS has teamed up with TrueVision Systems and Leica Microsystems to create the TruePlan. This surgical planning application is designed to optimize corneal incision guidance and IOL positioning during cataract surgery; it is now linked to the Oculus Pentacam AXL software.

OCULUS Pentacam AXL

The Pentacam AXL enhances clinical applications while providing optical biometry for IOL power calculations. The Pentacam IOL calculator has standard IOL formulas and latest-generation formulas, such as the Savini toric calculator and the Barrett formulas.

Leica Microsystems develops and manufactures high-precision surgical microscopes that integrate digital imaging technologies.

Optovue’s new AngioVueHD can capture wider images, allowing surgeons the image quality they are accustomed to seeing in a smaller imaging format (3 mm x 3 mm) albeit in a larger field of view. This technology lets them eliminate taking two scans. The sample density measures from 304x304 A-scans to 400x400 A-scans, which is 73% more than available previously. Because the new device can quickly provide high-resolution images of the retinal vasculature, it is suited for patients with retinal disease marked by changes to the vasculature, such as wet AMD and diabetic retinopathy.

German-based Plusoptix presented a line of binocular portable autorefractors aimed at pediatric patients. “They have smiley face screens and one model has kitten ears, so they are kind of adorable,” says Stephanie Becker, MD. Advantages include portability, so that pediatric patients who don’t fit in the autorefractor can be accommodated, and the autorefractors can take a measurement from three feet away, eliminating the need to dilate patients’ pupils. It also helps screen for strabismus. “I anticipate it making it far more efficient to see children and adults who have difficulty with the standard table top autorefractor, such as wheelchair patients,” says Dr. Becker. “I had the company rep autorefract me, and it was spot on.”

Plusoptix A16

Quantel Medical has received FDA approval for the Easyret integrated 577-nm yellow photocoagulator, designed to treat certain types of macular edema and peripheral retinal pathologies. The company says the Easyret has numerous settings for the treatment of ocular pathologies, including DR, macular edema and central serous chorioretinopathy. Surgeons can treat a single spot, a pattern of simultaneous targets or they can customize short pulses to accurately manage the thermal effect on targeted tissues.

Topcon’s recently FDA-approved Pascal Synthesis TwinStar laser photocoagulator features both yellow 577-nm and red 638-nm wavelengths. The optional Endpoint Management technology software for subthreshold laser treatment works with the 577-nm wavelength and integrates with the Topcon SL-D4 slit lamp.

Topcon says the red wavelength is ideal for providing deep, gentle penetration and effective treatment of choroidal vessels. The device is intended to perform single-spot photocoagulation in the posterior segment (retina, choroid) as well as pattern-scanning photocoagulation in the nonmacular retina.

Zeiss’ Veracity cataract surgery platform is “a surgical planning software that brings all of the planning data together with one click,” in the words of Dr. Donnenfeld. An intuitive cloud-based platform for cataract surgery planning, logistics, treatment, risk management and analysis, Veracity helps cataract surgeons by synthesizing critical data through integration with EHR systems and diagnostic devices. It then presents the data that are needed at each step of the procedure, with the goal of helping cataract surgeons work more efficiently, reduce risks, provide personalized care and improve outcomes.

Alcon CyPass

Dr. Patterson believes Zeiss’ Veracity platform has “the chance to revolutionize the game regarding preoperative counseling/postoperative counseling and intraoperative streamlining of cases.”

Zeiss’ Veracity

Zeiss’ medical technology business group acquired Veracity Innovations LLC earlier this year, which was founded by Kerry D. Solomon, MD, and Kyle Smith, MD. OM

OM also included information from company press releases.