Eyeworld Daily News

EW SHOW DAILY 6 ASCRS News Tuesday, April 17, 2018 Following, Douglas Rhee, MD, Cleveland, took to the podium as the first presenter, speaking about the purpose and current status of the ASCRS endophthalmitis clinical study, or the Topical vs. Intracameral Moxifloxacin for Endophthalmitis Prophylaxis study (TIME study). "It's about time for this study to occur," Dr. Rhee said. While there are, of course, tra- ditional approaches to endophthal- mitis prevention, such as povidone iodine sterile prep preoperatively, antibiotics (delivered a variety of ways) immediately postoperatively, and postoperative topical antibiotics using third- or fourth-generation fluoroquinolones, more recently, Dr. Rhee said, there has been increased interest in intracameral antibiotics. A widely cited study conducted by ESCRS showed the superiority of intracameral cefuroxime, and intra- cameral vancomycin was commonly used in the U.S. prior to awareness of its association with the rare but devastating complication hemor- rhagic occlusive retinal vasculitis. Since then, those favoring intraca- meral antibiotics in the U.S. might have switched to moxifloxacin, but there is only retrospective evidence to support its use and no approved pharmaceutical product, Dr. Rhee said. As such, the ASCRS Research Committee set out to design a study with the hypothesis that intracamer- al moxifloxacin is superior to topical moxifloxacin for the prevention of postoperative endophthalmitis. "This will be the largest study ever done in the history of ophthal- mology. It will be one of the largest studies in the history of medicine," Dr. Rhee said. The study design—which will involve a control group receiving a placebo intracameral injection and topical moxifloxacin drops and an experimental group receiving intra- cameral moxifloxacin and placebo drops—is nearly complete. The com- mittee and working group involved with this study is nearly done with grant writing and has engaged with a variety of stakeholders including the National Institutes of Health, Food and Drug Administration, Vet- eran's Administration, and potential corporate partners. Site selection has not yet occurred. If the committee's hypothesis is proven correct, Dr. Rhee said the research would change postoperative management of endophthalmitis prevention for all cataract surgery patients. It also would have the potential to provide a better patient experience postoperatively. Randall Olson, MD, Salt Lake City, spoke about using a femtosec- ond laser to adjust already implant- ed IOLs. The 400 nm femtosecond laser that uses low amounts of ener- gy to increase hydrophilicity of the lens and slightly alter its refractive index, making it possible to precise- ly adjust the lens, is being developed by Perfect Lens (Irvine, California). The average time such a treatment takes is 20 seconds, Dr. Olson said. Rabbit studies have shown its effica- cy in precise refractive adjustment, including the possibility for several subsequent adjustments, and safety with no signs of inflammation or cellular flare, he continued. This technology could open the potential to operate on all pseu- dophakic patients who want further corrections, allowing patients to choose from monovision variants, multifocality, and depth of field. Changes over time can be corrected, the range per treatment can be at least ±5 D, and higher order aberra- tions could be corrected, Dr. Olson said. Daniel Schwartz, MD, San Francisco, also spoke of technolo- gy that has the ability to adjust an implanted IOL. He first conceived of the Light Adjustable Lens and Light Delivery Device (RxSight, Aliso Viejo, California), both of which received FDA approval in Nov. 2017, more than 20 years ago. The general idea is that a 365 nm near-UV light is shined at a spe- cific area, changing a concentration of monomers that then move within the IOL to equalize their concentra- tion, thus changing the IOL's shape. Once the desired refractive change is achieved and confirmed, light is ap- plied universally over the lens area to lock the power in place. While this technology can enable postoperative correction, Dr. Schwartz said he thinks it will allow for presbyopia correction after cata- ract surgery when the patient has a clear visual axis and can understand their refractive options. Another presentation detailed a virtual reality headset (nGoggle, San Diego) that measures brain activ- ity and could be used to improve accuracy and the patient experi- ence of visual field loss assessment. The nGoggle, according to Felipe Medeiros, MD, PhD, Durham, North Carolina, could provide these objective measurements in a home, self-testing setting with the pos- sibility of a larger number of tests being acquired over time to improve detection of change and allow for screening in remote locations. Saya Nagori, MD, Garden City, New York, spoke about the consumerization of healthcare and the various applications of how telemedicine can help provide the convenience and tailored experience that people have come to expect in all areas of their lives. EW Editors' note: Dr. Olson has finan- cial interests with Perfect Lens. Dr. Schwartz has financial interests with RxSight. Dr. Medeiros has financial interests related to his comments. Dr. Nagori has financial interests with Simple Contacts (New York). Dr. Rhee has no financial interests related to his comments. Innovators continued from page 1 "Best of ASCRS 2018" highlights outstanding papers from the meeting T he "Best of ASCRS 2018" will help attendees catch up on all of the ASCRS meeting highlights in one session. This special wrap-up session will highlight some of the most important and interesting papers presented at the meeting from among the "Best Paper of Session" winners. Following summary presentations of the best papers, the section editors of EyeWorld mag- azine will debate the conclusions and implications in a free-flowing panel discussion. Eric Donnenfeld, MD, will moderate the session, and panelists will include Reay Brown, MD, David Chang, MD, Edward Holland, MD, and Vance Thompson, MD. "Best of ASCRS 2018" is an excellent way to get an overview of the meeting highlights, according to Dr. Holland. The session will take place today from 1:00–2:30 p.m. on Level 3, Ballroom C. EW Dr. Olson describes in vivo IOL adjustment using a low energy femtosecond laser.

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