Eyeworld Daily News

EW SHOW DAILY 22 Monday, April 28, 2014 ASCRS Symposia I n what has become a yearly symposium, the Alliance of the Cataract & Refractive Specialty Societies brought together an international field of experts to discuss the "best of" from various societies around the world. The moderator was Edward J. Holland, MD, and the co-moderators were Graham D. Barrett, FRANZCO, Roberto Bellucci, MD, and William C. De La Peña, MD. The majority of presentations concentrated on phakic IOLs, with the general out- comes showing very few differences among the three types of lenses. Several of the lenses discussed are not commercially available in the U.S., including the Visian ICL with CentraFlow (STAAR Surgical, Mon- rovia, Calif.) and the Cachet (Alcon, Fort Worth, Texas). Additionally, the foldable version of the Verisyse (Abbott Medical Optics, Santa Ana, Calif.) is not commercially available in the U.S. either. Other topics dis- cussed included infectious keratitis and the Light-Adjustable Lens (Calhoun Vision, Pasadena, Calif.). Infectious keratitis in Asia The aim of the Asia Cornea Society Infectious Keratitis Study (ACSIKS) is to study infectious keratitis in Asian countries, so as to improve strategies for prevention and treatment, and to reduce the burden of blindness in Asia, said Donald T.H. Tan, FRCS (Singapore). "Quite a few epidemics" were first recognized in the Asian region, including the fungal keratitis and Acanthamoeba keratitis cases related to contact lens wear. "Microsporidia is becoming an emerging problem in the Asian region," he said, as is serious multidrug resistance. Study centers from India, China, Thailand, Japan, Korea, Taiwan, Philippines and Singapore are participating, he said, and there are 6,569 cases that have been enrolled, with 5,834 cases available with preliminary analysis finished. "India has the most cases enrolled, with about 3,000," Prof. Tan said. "In East Asia, keratitis is mostly from contact lens wear, whereas in other areas of Asia, it's mostly trauma." Overall, trauma was the leading cause of infectious keratitis, accounting for 52.7% of all cases and contact lenses accounting for 17.7%, Prof. Tan said. Of the cases, 20% of the referring physicians recognize there is an infection, but no cause has been identified. "On smear, fungal elements were identified in 34% of the cases," Prof. Tan said. Microbial culture results were similar, with fungal causes account- ing for 46.3%; gram-positive bacter- ial cultures were identified in 20% and gram-negative in about 20% as well, he said. "In India, China, and the Philippines, fungal infection is more prevalent, whereas in Singapore and Japan, contact lenses are more often the cause," he said. The second phase of the analysis will study antimicrobial susceptibil- ity profiles of the fungal and bacter- ial causes, he said. "These studies will focus on evaluating the resist- ance of the most common bacterial infections to the current available antibiotics, performing DNA testing to compare our strains with bacterial infections in the West, and to developing new diagnostic tests and anti-infective therapies tailored to corneal infections in Asia," Prof. Tan said. Prof. Tan noted Alcon, Allergan, and Bausch + Lomb are funding the study. Light-Adjustable Lens showing promise With traditional IOLs, a complex lens selection process using biomet- ric data is required, said Arturo Chayet, MD (Mexico). "This results in high variability in visual performance in post-refractive surgery patients." With adjustable blended vision (ABV), a new lens allows for excel- lent intraocular distance, intermedi- ate, and near vision, he said. The Light-Adjustable Lens "achieves this by increasing the depth of focus." The binocular aspheric approach allow for optimal blending between both eyes, he said. Typically, they are adjusting the dominant eye for distance and the non-dominant eye for near/intermediate. Results from his first 20 patients (mean age was 67.9 years, with corneal astigmatism under 2.25 D), 35% of patients were 20/16 binocu- larly before the adjustment, and after the adjustment at postop week 1, 75% were 20/16. Similarly, for distance vision, 70% were 20/20 ini- tially, which improved to 85% after adjustment. For intermediate vision, 20% were 20/25 initially, which im- proved to 75% after the adjustment. With near vision, 15% were 20/32 initially, which improved to 90% after the adjustment. Results with this lens "were bet- ter than with the ReSTOR (Alcon), he said: 20/20 distance vision was achieved in 60% with the ReSTOR vs. 85% with the LAL, intermediate J2 vision was reached in 76% and 100% of the ReSTOR and LAL patients, respectively, and near J2 or better was reached in 92% and 90% of the ReSTOR and LAL patients, respectively. "The LAL demonstrated in this small study to safely and effectively deliver outstanding near, intermedi- ate, and distance visual acuity," Dr. Chayet said. "It is the future of presbyopic correction." EW Best of cataract and refractive papers from around the world by Michelle Dalton EyeWorld Contributing Writer Dr. Barrett was a co-moderator of the "Combined Symposia of Cataract and Refractive Societies."

• Cover