Eyeworld Daily News

EW SHOW DAILY 30 ASCRS Symposia Sunday, April 19, 2015 by Erin L. Boyle EyeWorld Editor Symposium highlights 'new technology from the old world' & Refractive Surgeons (ESCRS) and American Society of Cataract & Refractive Surgery (ASCRS), high- lighted these new and potentially upcoming technologies in Europe that are spreading around the world. Roberto Bellucci, MD, Verona, Italy, chaired the session for the ESCRS, and Edward J. Holland, MD, Cincinnati, chaired the session for the ASCRS. After each European physician finished his presentation, a panel of ASCRS representatives— Douglas D. Koch, MD, Houston; Stephen S. Lane, MD, Stillwater, Minn.; and Kerry D. Solomon, MD, Mt. Pleasant, S.C.—asked questions about the technology presented. Oliver Findl, MD, Vienna, Austria presented "Focusing on In- termediate Vision: New Technology IOLs [NTIOLs]." He discussed results from 2 NTIOLs: Lentis Comfort (Topcon, Tokyo) and Tecnis Sym- fony extended range of vision IOL (Abbott Medical Optics, Abbott Park, Ill.). He also discussed the KAMRA corneal inlay by AcuFocus (Irvine, Calif.), which just received Food and Drug Administration approval for use in the U.S. on Friday. He said that a multicenter, open-label study of the KAMRA is set to start this month in 13 sites in Europe. Results are anticipated for that trial at the end of 2015. Rudy M. Nuijts, MD, Amster- dam, gave the "New and Evolving Toric Trifocal IOLs" overview. He discussed 2 toric trifocal diffractive lenses, the FineVision diffractive N ew innovations continue to develop in the "Old World"— i.e., Europe — and find their way to the "New World" —the U.S.— according to experts from across the pond at a symposium here. Many of these innovative lenses and devices might not sound familiar to U.S. surgeons, but are regularly used and currently under study throughout Europe. The "New Technology From the Old World/ Assessment by the New World" symposium, jointly sponsored by the European Society of Cataract Steve Charles, MD, Memphis, Tenn., highlighted the importance of spectral-domain OCT in prevent- ing visual surprises after cataract surgery. There are many macular diseases that can't be seen on a dilated fun- dus exam, Dr. Charles said, so OCT is critical for evaluating the macula. Rather than using time-domain OCT, surgeons should be using spec- tral-domain OCT, he said. "All OCT is not created equal, and all ways of using OCT are not created equal," he said. Be sure to look at every slice of the spectral-domain OCT scan, he said, rather than looking at just 1, and don't let the photographer or technician pick the images for you. "Would you want someone to operate on your eye when they've only looked at 1 scan out of 20?" he asked. Keith A. Warren, MD, Over- land Park, Kan., shared his pearls for treating cataract patients who develop postoperative cystoid macu- lar edema (CME). The mechanism of CME is not clearly understood, Dr. Warren said, but it is believed that postop inflammation causes a break- down of the blood-retinal barrier. Do a careful pre-treatment eval- uation, Dr. Warren said, by taking a clinical history, doing a dilated fundus exam, fluorescein angiogra- phy, and OCT. Corticosteroids are the drugs of choice for treating CME because they have a broad mechanism of action, downregulating or inhibit- ing every part of the inflammatory cascade. NSAIDs are also useful, Dr. Warren said, but no NSAID is indicated for CME, so these drugs would need to be used off-label. For acute or persistent CME, Dr. Warren prefers to do a sub-Tenon's steroid injection because he believes compliance is a big issue with these patients. For chronic or resistant CME, he'll switch to an intraocular injection. William F. Mieler, MD, Chica- go, closed the session by moderating a case discussion with the panelists and audience. EW Editors' note: Dr. Boyer has financial interests with Aerpio Therapeutics (Blue Ash, Ohio), Alcon (Fort Worth, Texas), Allegro Ophthalmics (San Juan Capistrano, Calif.), Allergan (Irvine, Calif.), Bayer (Leverkusen, Germany), Genentech (South San Francisco), GlaxoSmithKline (Brentford, U.K.), OHR Pharmaceutical (New York), Regeneron Pharmaceuticals (Tarrytown, N.Y.), and ThromboGenics (Iselin, N.J.). Dr. Charles has financial interests with Alcon. Dr. Mieler has financial interests with Genentech. Dr. Olsen has financial interests with Haag-Streit AG (Koniz, Switzerland), and IOL Innova- tions (Aarhus, Denmark). Dr. Warren has financial interests with Alcon, Dutch Ophthalmic (Exeter, N.H), and Genentech. Pearls for continued from page 28 toric IOL (PhysIOL, Liege, Belgium) and the AT Lisa (Carl Zeiss Meditec, Jena, Germany). Trifocal diffractive multifocal IOL (MIOL) technology increases intermediate visual acuity without compromising distance and near, he said. "The visual acuity is pretty good for distance, intermediate, and near compared to diffractive bifocal MIOLs," Dr. Nuijts said. "Defocus curves for intermediate visual acuity appear better up to around 0.15 logMAR. Incidences of optical phenomena appear similar." Gerd U. Auffarth, MD, Heidel- berg, Germany, discussed "High Add Segment Multifocal and Macular Degeneration," specifically address- ing the Oculentis Mplus High Add lens (Berlin) in macular degener- ation cases. He has implanted the lens in 8 of these patients with a median age of 78.5 years. After the "straightforward" implantation, pa- tients were able to read a newspaper and prepare food without assistance, which is significant for this patient population, he said. "We're not talking about 20/20," Dr. Auffarth said, "but this is a great result." For instance, one satisfied patient found that cooking was possible without use of a magni- fying loupe, he said. "The magnifying effect of the IOL leads to an independence from other magnifying tools for perfor- mance of daily activities. There's good fundus visualization and OCT imaging quality," he said. Stefano A. Gandolfi, MD, Par- ma, Italy, presented "An Overview of Glaucoma New Devices and Stents." He outlined 3 possible strategies for glaucoma surgical treatment: redilat- ing the Schlemm's canal; bypassing the trabecular meshwork into the Schlemm's canal; and diverting the aqueous humor into the supracho- roidal space. He discussed how the Hydrus (Ivantis, Irvine, Calif.), Trabectome (NeoMedix, Tustin, Calif.), iStent (Glaukos, Laguna Hills, Calif.), SOLX Gold Shunt (SOLX, Waltham, Mass.), and CyPass (Tran- scend Medical, Menlo Park, Calif.) fall into those categories. "All of these devices and stents are safer than trabeculectomy," he said. But "these devices are not easy and have to be implanted in gonio- scopic view." Jesper Hjortdal, MD, PhD, Aarhus, Denmark, presented "Field Study of the SMILE [small incision lenticule extraction, Carl Zeiss Med- itec] Refractive Procedure." Farhad Hafezi, MD, Geneva, Switzerland, closed the symposium, presenting for Theo Seiler, MD, Zurich, who could not attend, on "Expanding Modalities of CXL." EW Editors' note: Dr. Gandolfi has finan- cial interests with Alcon (Fort Worth, Texas), Ivantis, and Glaukos. The other physicians have no financial interests related to their comments. Dr. Findl discusses NTIOLs and a newly FDA-approved inlay at a new technology symposium.

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