Article

AAO product highlights

OM’s editorial board shares the new technology that stood out at the 2018 AAO meeting in Chicago.

The show floor at October’s AAO meeting in Chicago featured a plethora of innovative products. The exhibit hall was littered with diagnostics, therapeutic and treatment technology in dry eye, retina, glaucoma and more. If you attended the meeting, you were sure to get in your “10,000 steps” by day’s end.

With a show of this magnitude, there is a good chance you did not see or hear about all of the products on display. That’s why we asked our editorial board to recap their highlights.

DIAGNOSTIC TECHNOLOGY

Diopsys hosted booth lectures featuring discussions of practical applications of Light-Induced Visual-response (LIV) testing in ophthalmic practice. LIV tests are non-invasive and evaluate how the cells within the vision system are functioning. Steven M. Silverstein, MD, delivered one of the lectures. “LIV testing is both underappreciated and underutilized in modern eye care, despite that it is the only testing that gives us objective information about retinal function,” he said via press release.

Lumenis’ Antares is a corneal topographer that offers advanced tear-film analysis. Its applications include noninvasive tear break-up time analysis, MGD lipid layer grading, infrared meibography and pupillography.

Nidek launched the Gonioscope GS-1. This automated gonioscopy device enables 360° color iridocorneal angle imaging using a 16-surface multi-mirrored prism lens. Its Automated Angle Detection provides guidance for capturing the angle.

The Oculus Smartfield perimeter is optimized for examinations for functional impairment of the central visual field, but is also suited for peripheral measurements. The Smartfield performs standard automated perimetry using an ultra-high luminance LCD display.

PDI Check is a novel near-vision testing game developed for the Nintendo 3DS gaming console. PDI Check measures monocular near visual acuity, color vision and stereopsis.

Quantel’s recently FDA-approved LacryDiag is a complete diagnostic device for dry eye. It is an ocular surface analyzer that completes analysis of the three tear film layers with four non-contact exams: interferometry, noninvasive break-up time, tear meniscus and meibography.

Kamran M. Riaz, MD, says he was impressed with Tracey Technologies’ iTrace, a ray-tracing wavefront and corneal topography combination device. Along with its ability to perform refraction, keratometry and pupillometry Dr. Riaz thinks refractive cataract surgeons will be excited with other unique features. “For example, it has the ability to quantify angle-alpha and angle-kappa, which would be useful for premium IOL surgery and refractive surgery, respectively, to better identify good candidates. It also has the ability to give a visual representation of what the patient may be seeing in regards to higher-order aberrations, which I think we as a specialty are slowly appreciating the role they play in patient satisfaction after premium IOL and refractive surgery.”

TREATMENT EQUIPMENT/DEVICES

Alcon’s PanOptix trifocal IOL is the first hydrophobic trifocal lens built on Alcon’s AcrySof IQ platform. The AcrySof IQ PanOptix IOL has an intermediate focal point at 60 cm combined with the rotational and axial stability of the AcrySof single-piece design. This has not yet received FDA approval.

Bausch + Lomb hosted wet-lab sessions for the enVista toric MX60T hydrophobic acrylic IOL for astigmatism correction. This IOL features a one-piece, aberration-free, aspheric optic with fenestrated, step-vaulted, modified C-loop haptic design that offers rotational stability and predictable astigmatism correction. Also, the company’s 25- and 27-gauge Bi-Blade dual port vitrectomy cutters are exclusive to the Stellaris Elite surgical platform. The Bi-Blade design offers an effective cut rate of 15,000 cuts per minute, consistent flow rate and reduced retinal traction.

Dr. Silverstein says the Ellex 2RT laser was the most promising technology he saw at AAO. Not approved yet in the United States, 2RT, or Retinal Rejuvenation Therapy, stimulates the eye’s natural healing response to treat the early stages of AMD. “It is an SLT-like application to the macula in order to rejuvenate cells and significantly decrease the incidence of dry AMD converting to wet AMD,” Dr. Silverstein says.

Michael Patterson, DO, thinks Ivantis’ Hydrus Microstent has given the MIGS market something that could give dramatic pressure-lowering effects. “We have been wanting something to show long-term promise, and this just might be the device.”

Cynthia Matossian, MD, FACS, liked Iantech’s miLOOP device for cataract surgery, which allows zero-energy lens fragmentation to help surgeons consistently and thoroughly dissect without applying outward forces on the zonules. Prior to AAO, Zeiss announced an agreement to acquire Iantech.

One of Mitchell A. Jackson, MD’s highlights was the Lensar Laser System’s latest system upgrade, Streamline IV. In particular, he noted the IntelliAxis-L Steep Axis Capsular Marking, which enables precise verification of the steep axis relative to toric IOL alignment, both intraoperatively and postop.

Lumenis’ M22 provides a solution to skin inflammation and skin-related problems. M22 combines with intense pulsed light (IPL) with Optimal Pulse Technology to treat skin and eyelid inflammation, which can be the root cause of ocular surface problems.

Kevin Corcoran, COE, CPC, FNAO, was most interested in LumiThera, which is developing photobiomodulation treatment protocols for the treatment of dry AMD. The Valeda Light Delivery System is being studied for the treatment of dry AMD and other ocular diseases and disorders and is not approved for sale in the United States, although the company recently announced a collaboration with Optos to commercialize Valeda in Europe.

Lisa Nijm, MD, JD, has been intrigued by RySurg’s BlephEx, a handpiece used to spin a micro-sponge along the edge of the eyelids and lashes to remove scurf and debris and exfoliate the eyelids. “The theory of removing the biofilm of bacteria that coats and clogs meibomian glands may be a key to helping our most severe dry eye patients,” Dr. Nijm says.

Laura Periman, MD, was impressed with Sight Sciences’ TearCare System, which uses customizable, wearable therapeutic eyelid technology to treat dry eye disease. The flexible devices conform to the eyelids to deliver a sufficient level of energy to liquefy meibum. This technology allows the patient’s eyes to remain open and blinking during the procedure.

Dr. Periman also mentioned Tear Film Innovations’ iLux, a handheld, LED light-based heating and compression treatment for meibomian gland dysfunction. The device features a single-use, disposable Smart Tip. Its inner pad slips behind the eyelid being treated, and the outer pad presses against the outer surface of the eyelid during heating and compression.

The Zeiss ReLEx SMILE procedure received FDA approval for expanded myopia treatment for patients with astigmatism. The company also announced that 1.5 million SMILE procedures have been completed globally. SMILE, or small incision lenticule extraction, is a minimally invasive refractive procedure performed with a VisuMax femtosecond laser.

THERAPEUTICS/MEDICATIONS

Earlier this year, Bausch + Lomb launched Lumify (brimonidine tartrate ophthalmic solution 0.025%), the first over-the-counter eye drop developed with low-dose brimonidine tartrate to treat eye redness. In clinical trials, Lumify eye drops demonstrated a strong safety and efficacy profile, low risk for rebound redness and 95% symptom improvement seen at one minute and lasting up to eight hours.

Eyenovia, a biopharmaceutical company, presented data on its latest EYN PG21 study. The study evaluated high-precision microdose technology of latanoprost, which demonstrated IOP lowering and successful patient usability. The company’s pipeline includes late-stage development of microdosed medications for myopia progression, glaucoma and other eye diseases delivered topically to the eye via its patented piezo-print technology.

EyePoint Pharma presented two products that will be available in 2019: Dexycu (dexamethasone intraocular suspension) 9% and Yutiq (fluocinolone acetonide intravitreal implant) 0.18 mg. Dexycu is first of many in-the-pipeline ophthalmic medications that will be available over the next couple of years, says Eric D. Donnenfeld, MD. “The results of the FDA trials show that Dexycu given into the anterior chamber at the conclusion of cataract surgery removes the need for topical corticosteroids.” Yutiq, which recently received FDA approval, is a micro-insert for chronic non-infectious uveitis. It is supplied in a sterile single-dose preloaded applicator.

Prior to AAO, Eyevance Pharmaceuticals announced the acquisition of Flarex (fluorometholone acetate ophthalmic suspension) 0.1% from Novartis AG. Flarex is indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment.

Inveltys (loteprednol etabonate ophthalmic suspension, Kala Pharmaceuticals) 1% is the first b.i.d. ocular corticosteroid indicated to treat postoperative inflammation and pain following ocular surgery. Inveltys utilizes the company’s proprietary mucus-penetrating particle (MPP) technology.

Dr. Silverstein noted that Omidria (phenylephrine and ketorolac intraocular solution, Omeros) 1%/0.3% received “an unprecedented extension of pass-through reimbursement” until Oct. 1, 2020. Data shows that Omidria added to irrigation solution and used during cataract surgery maintains iris tone, prevents intraoperative floppy iris syndrome and reduces surgical complications and surgical times.

Xelpros (latanoprost ophthalmic emulsion 0.005%, Sun Pharma) is a recently FDA-approved drug for the reduction of elevated IOP in patients with open-angle glaucoma or ocular hypertension. Xelpros is the first and, so far, only form of latanoprost that is not formulated with benzalkonium chloride.

AI/OTHER TECHNOLOGY

Alcon showcased its IOL inventory management device, “Wanda.” This a radio-frequency identification (RFID) technology that reads radio signals emitted by RFID tags in IOL packaging to inventory a practice’s supply in seconds. The company is also developing the SMART Suite, a digital platform for cataract surgery that will connect multiple diagnostic and surgical devices through a digital, open cloud-based infrastructure. SMART Suite is built on the Philips HealthSuite platform.

Bausch + Lomb, in partnership with IBM, announced the Eyetelligence applications that will run on the IBM Cloud to work with the Stellaris Elite vision enhancement systems. Features include expedited technical support and the ability to synchronize preferred surgical parameters across multiple Stellaris Elite systems.

Topcon and IDx, an AI diagnostics company, announced an exclusivity agreement that grants U.S. rights to IDx as the only autonomous AI company permitted to sell its products with the Topcon NW400, a robotic fundus camera. Topcon also announced the release and class II clearance of Harmony, a diagnostic data management application that enables software providers (like IDx), EHRs and other third-party manufacturers to integrate diagnostic results into one central location.

Zeiss is launching the Advanced Nerve and Glaucoma Imaging (ANGI) Network, which is aimed at advancing glaucoma research and findings in neuro-ophthalmology. The ANGI Network is made up of leading researchers in these fields who use the Plex Elite 9000 swept-source OCT to investigate retinal and optic nerve vasculature.

Also, Zeiss’ Integrated Diagnostic Imaging (IDI) platform is a software-driven multi-modality solution that gathers, combines and associates data from different diagnostics devices to improve treatment decisions and efficiency. IDI works with Zeiss instruments such as Cirrus OCT, Humphrey Field Analyzer HFA3, Clarus 500 ultra-widefield retinal camera and the Visulas green therapeutic laser. OM