ASCRS a hit despite low attendance

PHILADELPHIA — The number of attendees was down, but that did not prevent the American Society of Cataract and Refractive Surgery from presenting a diverse and exciting lineup of scientific information at its annual meeting here.

The meeting, which has broadened its scope in recent years to include glaucoma and most recently cornea sessions, featured speakers from all over the United States and Europe. The number of Asian participants seemed to be down from previous meetings, probably partially because of the meeting’s location on the East Coast and partially because of reluctance to travel to the United States since the attacks of Sept. 11. The ASCRS press office said overall physician attendance was more than 3,600, about 22% down from last year’s meeting in San Diego.

Despite the decrease, the meeting featured the largest number of papers at any meeting to date on wavefront technology, according to incoming ASCRS President Marguerite B. McDonald, MD. There were also numerous presentations on new and forthcoming IOL designs; on LASIK, LASEK and PRK; and on the practice surveys that have become a high point of the ASCRS opening session.

ASCRS also trumpeted its own lobbying and socioeconomic efforts at the meeting. The opening session featured a keynote speech by a congressman sympathetic to the pleas of ASCRS and other organizations for increased physician reimbursement. And a press conference later during the meeting announced a new effort by ASCRS to educate the public about LASIK.

First woman president

Dr. McDonald became the first woman president of a major American ophthalmology society at the opening ceremony here.

She replaces I. Howard Fine, MD, who served as president of the American Society of Cataract and Refractive Surgery for the past year. Both incoming and outgoing presidents spoke at the meeting.

Dr. McDonald called her appointment as ASCRS president “the highlight of my career” and outlined several initiatives that she hopes to undertake during her term. She also praised the diversity of ASCRS, which she said was in part responsible for the fact that she was chosen to head the organization.

Among the initiatives she announced for the coming year is a “jobfest” to be held this October. The idea of the ASCRS jobfest will be to introduce third year residents and fellows to private practitioners who might be interested in employing them. Dr. McDonald said this would be a good way to introduce new ophthalmologists to the organization and hopefully recruit them as lifelong ASCRS members.

She also introduced a new ASCRS program to support ophthalmic research without influence from manufacturers, the Envisioning the Future of Eyecare program.

Dr. McDonald said the fund will support short-term research projects. One such project already funded was an analysis of the corneal flaps created by a variety of commercially available microkeratomes. Another will be an infection control study.

The ASCRS Foundation, a new philanthropic organization, will administer the funding. Dr. McDonald announced that the Foundation has already raised $2.9 million from just its initial 13 donors, on the way to a minimum goal of $4 million this year. She said the Foundation is challenging itself to go beyond this initial goal to raise $5 million for the year.

Keynoter highlights reform

The health care system in the United States is in crisis because of government interference, according to a congressman with a keen interest in reform of Medicare and other programs.

“Health care reform is critical for the nation,” said Rep. John Shadegg, R-Ariz., the keynote speaker at the opening session.

Speaking by live satellite hookup from his home state, Mr. Shadegg said the weakened state of the physician-patient relationship in the United States is due to well-meant but misguided governmental tampering with health care.

A patient’s bill of rights and reform of long term health care are sorely needed, he said, and he has been involved in championing both efforts in Congress.

Mr. Shadegg spoke about the disillusionment expressed to him by physicians in his constituency. He said doctors have told him they no longer find medicine rewarding because of the bureaucracies they deal with, both in government and private insurance.

The government has placed employers and insurance companies between physicians and their patients, Mr. Shadegg said, but it does not have to be that way.

“If we look at what has caused these problems, we can get back to the way it was before,” he said.

He is championing the idea of changing the way employers support the health care system. Instead of providing the same plan for all employees, companies could give employees a certain amount of money to use toward health care and allow the employees to choose their own plan. This would involve the employee directly in shopping for a plan that serves him or her well for a reasonable price.

Mr. Shadegg urged physicians to get involved in health care reform, both through support of ASCRS and through their own dealings with their elected representatives. He said only through involvement can physicians help to shape the reforms the U.S. health care system currently needs.

LASIK guidelines for consumers

Guidelines devised by a new ASCRS committee will help people who are interested in LASIK decide for themselves whether they are appropriate candidates for the procedure, according to members of the committee.

The guidelines, created in response to a consumer survey that showed low awareness of some basic facts about LASIK, were announced here at a press conference.

Consumer self-education on LASIK can help people assess whether they are ideal, less than ideal, or noncandidates for LASIK, said members of the ASCRS Eye Surgery Education Council, the group that drafted the screening guidelines.

The market research firm Harris Interactive released a study in mid-March underscoring the need for increased patient education, members of the council said. The survey uncovered several common misperceptions about LASIK: 41% of respondents believed that anyone with imperfect vision is an appropriate LASIK candidate, 31% did not realize the surgery had to be performed by a licensed medical practitioner and 23% believed LASIK is a cosmetic surgical procedure.

“The information from Harris Interactive was absolutely a wake-up call to us as ophthalmologists” about the lack of patient education, said Dr. McDonald. “We decided to take action and form the ESEC. When patients are armed with knowledge, they make better decisions,” she said.

As an example of the public’s misconceptions, Roger Steinert, MD, chairman of ESEC, pointed to the almost 66% of respondents who were concerned about complications.

“The incidence of sight-threatening complications is less than 1%,” he said.

Dr. Steinert said ESEC has been given unrestricted grants from industry to achieve its patient education goal, and to date it has a $750,000 budget.

“These guidelines are the first of their kind,” he said.

The guidelines define characteristics of patients who are ideal candidates, less than ideal, and noncandidates for LASIK.

Ideal LASIK candidates include people who are over 18 who have had stable refractive errors for more than 2 years, have sufficient corneal thickness, do not suffer from any disease that would affect the outcome of the surgery and are adequately informed about the benefits and risks of the surgery.

Less-than-ideal LASIK candidates are people who have a history of dry eyes, are being treated with medications such as steroids or immunosuppressants or have scarring of the cornea.

A LASIK noncandidate is someone who has a disease such as cataract, glaucoma, corneal disease or corneal thinning disorders; does not give informed consent; or has unrealistic expectations.

Dr. Steinert said the ESEC plans to expand its patient education campaign to include all refractive surgeries, but there is not yet a timeline for implementation of further guidelines.

The ESEC has a Web site (www.eyesurgeryeducation.com) and a toll-free phone number (800-536-ESEC) for consumers to garner additional information on the procedure.

Surveys: optimism about wavefront

Use of wavefront-guided ablation technology increased to 10% last year, up from 2.5% reported in 2000, according to results of an annual ASCRS survey.

Additionally, of the survey respondents who had performed wavefront-guided ablations, 75.3% think it will improve quality of vision. When asked if they would convert back to photorefractive keratectomy if it is shown to provide better results with wavefront technology, 56.8% answered yes.

Kerry D. Solomon, MD, presented the results of the survey here at the opening session. He said that of 11,423 surveys sent out to all members of ASCRS and the European Society of Cataract and Refractive Surgeons, 1,407 responses were received.

According to a separate survey, the Visx excimer is the laser of choice among members of ASCRS.

David V. Leaming, MD, presented the results of his annual survey of members of ASCRS, the European Society of Cataract and Refractive Surgeons and the Pan-American Association of Ophthalmology.

Dr. Leaming said 72% of ASCRS survey respondents reported using the Visx excimer laser, while 19% use the Alcon Summit Autonomous laser. Of ESCRS responders, 33% use the Bausch & Lomb Technolas 217 and 22% use the Nidek excimer. The Visx excimer was also named most often (37%) by responders from the Pan-American Association of Ophthalmology.

Dr. Leaming’s survey also revealed that among all respondents, 56% of ASCRS members, 38% of ESCRS members and 47% of PAAO members use an excimer laser.

The survey was mailed to 5,686 ASCRS members; 1,130 were returned. In addition, 775 surveys were collected at the ESCRS meeting in Amsterdam in September 2001; 656 of these responders were from Europe. At the PAAO meeting in Buenos Aires in July 2001, 1,200 surveys were collected. This represented 40% of attendees, 62% of whom were from Argentina.)

With respect to multifocal IOLs, 12% of ASCRS responders demonstrated a high interest, as well as 24% of ESCRS responders and 19% of PAAO responders. For toric IOLs, 10% of ASCRS and ESCRS responders regard them with high interest, and 8% of PAAO responders.

For limbal relaxing incisions for astigmatism, 29% of ASCRS, 23% of ESCRS and 23% of PAAO responders reported a high interest.

Dr. Leaming’s survey, entitled Practice Styles and Preferences of U.S. ASCRS Members: 2001 Survey with International Comparisons, was also presented as a poster. Dr. Solomon’s survey, too, was presented in poster form.

Innovator: IOL styles improving

Improved IOL designs have greatly reduced the incidence of posterior capsular opacification, which may soon be on its way to extinction, according to David J. Apple, MD.

Dr. Apple gave this year’s Innovator’s Lecture, entitled “The Future of Ophthalmic Biodevices: The Scene Is Changing.”

During his lecture, Dr. Apple discussed what he called the “wonderful” advancements in IOL technology. He said there is currently a trend of returning to older IOL designs. As an example he cited the sharp edges on the optics of IOLs from a number of manufacturers that are reducing rates of PCO. He noted that sharp optic edges were a common characteristic of IOLs in the early 1980s.

Dr. Apple noted that reduction in PCO, while partially dependent on advances in IOL design, is also dependent on good cortical cleanup and the surgeon’s skill and technique.

He gave credit to earlier innovators and their achievements in ophthalmology, making specific reference to Charles Kelman, father of phaco, and Harold Ridley, the first surgeon to implant an IOL.

Dr. Ridley changed the focus in ophthalmology from “taking things out of the eye to putting things in the eye. He unlocked the posterior chamber for all the things we are now doing,” Dr. Apple said.

Dr. Apple said the techniques and principles of general pathology are also important in ocular pathology, and an understanding of general biological processes helps in an understanding of ocular processes.

“All the techniques used to analyze plastics in general medicine are also useful to evaluate IOLs in the eye,” he said.

Dr. Apple said, however, that he sees the future of ocular pathology as “dim” due to the closing of pathology laboratories throughout the country. He said he wants to stay involved and help keep work in ocular pathology going. He suggested the creation of an entity to advance investigation in pathology.

Thousands of ophthalmologists attended the Innovator’s Session at which Dr. Apple spoke. The Innovator’s Session is consistently one of the best attended sessions during the ASCRS meeting.

“This is the largest group to attend a purely scientific session in all of ophthalmology,” Manus Kraff, MD, ASCRS program director, said of the several thousand attendees who filled two adjacent meeting rooms. “This session is the highlight of the meeting. This is a society based on innovations. The innovators don’t just give a lecture one year, and then we don’t hear from them again. They come back each year. They let us know what they are doing.”

In addition to the Innovator’s Lecture, the session also honors ophthalmic colleagues who have reached the forefront of their fields by challenging themselves to create better and safer technologies. The session began with a tribute to D. Peter Choyce, MD, who died earlier this year. Dr. Choyce, a developer of angle-fixation IOLs, was a protege of Dr. Ridley.

I. Howard Fine, MD, spoke on new perspectives in cataract and refractive surgery. One of the highlights of his presentation was his take on refractive lens exchange.

“This will be the way things are going,” Dr. Fine said. “This is a fee-for-service procedure. The patient won’t need spectacles, and senior patients will never get cataracts.”

Other session topics included “Zernikes: breakfast of champions?” by Stephen Klyce, MD; “PAI-LASIK and other new approaches to unmet needs in ophthalmology,” by Gholam Peyman, MD; “Creative strategies for clearing the high astigmatism hurdle,” by James Gills, MD; “Presbyopic LASIK,” by Luis Ruiz, MD; “Large penetrating keratoplasties: Immunologic and refractive aspects,” by Joaquin Barraquer, MD; “Solus aegroti suprema lex,” by Robert Stegmann, MD; “New approach to creating pseudoaccommodation,” by David Miller, MD; and “Potpourri Three,” by Charles Kelman, MD.

Higher pricing for LASIK

Refractive surgeons are pricing LASIK higher than in recent years in an effort to distinguish themselves from other practitioners, according to market analyst David R. Harmon. Economic factors play a large role in people’s decisions to have the procedure and are slowing patients’ decision-making process, he said.

The number of laser centers is growing faster than the volume of LASIK procedures, but the market penetration of laser surgery remains low, Mr. Harmon said. It is expected to grow significantly, however, with 20% penetration in the United States by 2015, “which is how long it took contact lenses to penetrate 20% of the market,” he said. He spoke here at the Outpatient Ophthalmic Surgery Society meeting held concurrently with the ASCRS meeting.

Surgeons are starting to move toward more high-end pricing for LASIK procedures, in contrast with the discount pricing trend of only a few short years ago, he said.

“This is the result of practices trying to separate themselves out. [They are] trying to say ‘I’m the highest priced guy in town,’ as part of their marketing strategy,” he said.

Mr. Harmon said the approval and availability of new technologies such as wavefront diagnostics and customized ablations should drive LASIK prices even higher in the near future.

According to Mr. Harmon, the average age and level of education of LASIK patients have not changed significantly over the past several years. “We are seeing this shift down into lower levels, which is a good sign, required to continue to grow LASIK,” he said.

Mr. Harmon said that there is a similar downward trend with income levels, but that most LASIK patients are still relatively affluent.

He said it takes more than a year for most patients to elect to have LASIK.

“That has a lot of implications in the way you market your practice and the way you stay in touch with your patients once they come in. If you’re only working them for a month, you’re going to lose these patients, because they are going to decide a year after they first come in whether or not to have the surgery,” he said.

Financing has remained fairly constant as a means of payment for LASIK surgery, at about 15%, Mr. Harmon said. Some patients are opting to pay for the procedure with credit cards, he said. About 32% of patients prefer to pay on credit.

Cataract

‘Cool phaco’ described

A new technology allows surgeons to perform “cool phaco,” using less ultrasound energy than standard phaco, according to presentations here.

In a comparative study, Allergan’s Sovereign with WhiteStar technology used less energy with shorter equivalent phaco times for the removal of dense cataracts, resulting in better corneal clarity than with a traditional phaco technique.

R. Bruce Wallace, MD, presented findings of the study, which compared phaco using the Allergan Sovereign to phaco using the Sovereign with WhiteStar phaco.

Since the WhiteStar system employs a rapid pulse that results in less phaco energy and less heat than ultrasound, there is less epithelial cell loss with no possibility of corneal burn, Dr. Wallace said. He said the WhiteStar system allows high vacuum with less surge than in traditional phaco.

WhiteStar is an “incredible leap in technology that will help keep the anterior chamber stable. This may rival laser phaco as we move ahead,” Dr. Wallace said.

In a separate presentation, David F. Chang, MD, said brunescent cataracts can be safely removed using the WhiteStar technology.

“Brunescent lens removal is where we want to improve our technology,” he said.

In more than 700 cases, he said, he has removed 4+ brunescent lenses effectively using WhiteStar technology, which he called a “hyperpulse” software mode that can be used on a standard Allergan Sovereign phaco machine and handpiece.

“There is absolutely no risk of wound burns using cold phaco technology,” he said.

Dr. Chang’s equivalent phaco times ranged from 6 to 20 seconds, with a mean of 8.8 seconds during the first 20 cases, Dr. Chang said.

“There was noticeable improvement in followability and chatter reduction,” he said.

Dr. Chang said the technology could be used along with standard ultrasound and did not require altering fluidic settings or technique.

“The corneas were significantly clearer than I was previously accustomed to,” he said.

Improved contrast sensitivity

An IOL with a modified anterior optic surface may help reduce the eye’s own spherical aberration. Interim results with Pharmacia’s Tecnis IOL with Z-Sharp optic technology indicate the lens demonstrates “significantly better contrast sensitivity” than standard IOLs, said Mark Packer, MD.

Dr. Packer said a randomized, inter-individual clinical study showed that eyes implanted with the Tecnis IOL achieved better contrast sensitivity than eyes with a standard IOL at 3, 6, 12 and 18 cycles per degree spatial frequencies under photopic conditions and at 3 and 6 cycles per degree under mesopic conditions. Dr. Packer’s data showed a 38% improvement in mesopic contrast sensitivity and a 42% improvement in photopic contrast sensitivity at the peak region, he said.

“This data suggests wavefront technology will allow us to address the problem of spherical aberration and contrast sensitivity inherent in current IOL technology,” Dr. Packer said.

A second study in Germany found similar results.

Ulrich Mester, MD, analyzed 74 eyes in a randomized clinical study. Dr. Mester’s wavefront analysis showed that eyes with the Tecnis IOL had “almost no spherical aberration” compared to eyes that received a control spherical IOL (which had a positive spherical aberration of 0.8 D).

“Our clinical results support the theoretical, pre-clinical calculations that the spherical aberration of the eye after cataract surgery can be improved by modifying the anterior surface of the IOL,” Dr. Mester said.

Pharmacia’s foldable Tecnis lens is based on the company’s CeeOn Edge IOL. Using wavefront technology, Pharmacia modified the anterior lens surface to create the Tecnis.

The Tecnis has not yet been launched in the United States.

Accommodating IOL

The CrystaLens AT-45 accommodating IOL is showing efficacy in a phase 3 clinical trial, according to data presented here. The lens is providing good distance, intermediate and near vision for most patients.

Stephen Slade, MD, one of the investigators in the trial, presented preliminary results of 330 eyes of 270 patients implanted either unilaterally or bilaterally with the CrystaLens (C&C Vision).

Dr. Slade said this data was also recently presented before a Food and Drug Administration panel.

According to Dr. Slade, 79% of unilaterally implanted patients achieved uncorrected visual acuity (UCVA) of 20/30 or better and that 95% of bilaterally implanted patients attained a UCVA of 20/30 or better.

“The FDA grid, what they require, our target, was 92.5% [of patients] at 20/40 or better. We far exceeded that,” Dr. Slade said.

“For distance-corrected near visual acuity, 81% were 20/40 or better. Ninety-seven percent of these patients who had both eyes implanted with the CrystaLens could read at 20/40 or better.”

Dr. Slade said the intermediate visual acuities achieved were even better, with 96% of the unilaterally implanted eyes achieving 20/30 or better intermediate vision and 99% achieving 20/40 or better. He said 100% of bilaterally implanted eyes achieved intermediate visual acuity of 20/30 or better.

Dr. Slade said the visual results did not worsen in patients who required YAG capsulotomy. “If anything, they seem to get better,” he said.

Induced astigmatism in children

Temporal cataract incisions add to with-the-rule cylinder in pediatric patients, according to a study presented here.

Samuel Masket, MD, presented a retrospective chart review of 22 cases of pediatric cataract surgery. Incisions ranged from 3 mm to 6 mm, and location was either superior or temporal. Dr. Masket said superior incisions induced little or no change in astigmatism, whereas temporal incisions caused greater change than in adults.

“Temporal incisions add to with-the-rule cylinder,” Dr. Masket said. “Children do not respond well to limbal relaxing incisions. Those with superior incisions fared better. Children do not have deep-set orbits like adults do, so no temporal incision is needed,” Dr. Masket said.

DuoVisc vs. Healon5

DuoVisc offered better protection than Healon5 in high-flow phaco- emulsification, according to a 1-year prospective study.

Satish S. Modi, MD, randomly assigned 50 patients to use of either Healon5 (Pharmacia) or DuoVisc (Alcon Pharmaceuticals) as the viscoelastic during cataract extraction.

Dr. Modi said 100% of the patients in the DuoVisc group achieved visual acuities of 20/25 or better at 3 months compared to 80% in the Healon5 group. Pachymetry values and endothelial cell loss were significantly greater in patients in the Healon5 group. Significantly higher intraocular pressures were also reported in the Healon5 group for 2 days following surgery.

Lubricating jelly as filler

Injecting medical lubricating jelly into human cadaver eyes can help in teaching cataract surgery to medical residents, said Rosa M. Braga-Mele, MD. She said injecting a clear, water-soluble medical jelly, such as KY Jelly, into a human cadaver eye serves to help rehydrate the cornea, reducing corneal edema and enhancing corneal clarity.

Dr. Braga-Mele said the increased corneal clarity eases the learning curve for delicate intraocular procedures such as phacoemulsification and capsulorrhexis because it allows a finer view of the anterior chamber.

Dr. Braga-Mele said the jellies are a low-cost option that simulate the effects of viscoelastics.

Refractive

Wavefront for hyperopia, astigmatism

Wavefront-guided LASIK can potentially provide improved outcomes over conventional LASIK for treatment of hyperopia and mixed astigmatism, said Omar J. Hakim, MD.

Dr. Hakim said he has treated more than 100 hyperopic eyes with the Alcon LADARVision and CustomCornea Wavefront system as part of a phase 3 clinical trial. He compared his wavefront results to those in patients receiving a standard treatment.

“Results were similar between the two groups but should improve with further refinement,” Dr. Hakim said.

Study participants were treated for up to +6 D of sphere and up to –6 D of astigmatism. Follow-up was at 1, 3 and 6 months.

Postoperative higher-order aberrations were lower in the wavefront-treated group than in the standard treatment group. All patients in the wavefront group achieved best-corrected vision of 20/25 or better, Dr. Hakim said.

Visx laser for astigmatism

Hyperopic astigmatism can be treated effectively with the Visx Star laser system, said Noel Alpins, MD, at the meeting. He reported on a consecutive series of 97 eyes treated for hyperopia.

All eyes had a magnitude of astigmatism of less than or equal to the spherical error, Dr. Alpins said. Mean spherical equivalent preoperatively was +3.23 D. Postoperatively, the mean spherical equivalent was +0.09 D. Mean astigmatism before treatment was +1.4 D and postop was +0.5 D.

Dr. Alpins said adjusting the manufacturer’s nomogram allowed him to reduce astigmatism by up to an additional 30%. He said he used a coefficient adjustment of 1.30.

Hinge width and dry eye

Corneal sensation and dry eye syndrome were significantly greater in eyes with a narrow LASIK flap hinge than in eyes with a wider hinge in a study by Eric Donnenfeld, MD, and colleagues. They investigated the effect of hinge width on corneal sensation and dry eye following LASIK.

Fifty-four patients were studied. Hinge width was set to 12 mm in one eye of each patient and 6 mm in the other eye. The authors found that corneal sensation was reduced more in eyes with the narrow hinge than with the wider hinge.

Dr. Donnenfeld added that dry eye symptoms were greatest in the eyes with the narrow hinge and milder in eyes with the wider hinge throughout the 3-month follow-up period.

The corneal hinge in LASIK provides a conduit for innervation of the central cornea, he explained.

“We need to make a wider hinge,” he said.

Microkeratome abrasions

There can be a difference in the rate of abrasions between microkeratome brands, said Nada Jabbur, MD.

Dr. Jabbur and colleagues reviewed the records of patients undergoing LASIK with flaps created using either the Amadeus microkeratome (Advanced Medical Optics) or the Hansatome (Bausch & Lomb Surgical). The Amadeus caused fewer epithelial defects than did the Hansatome, the retrospective study found.

Dr. Jabbur reported that the overall incidence of microkeratome-related complications in the study was low. Patients who had flaps created using the Amadeus had a 5.3% abrasion rate (6 patients out of 113). In patients who had flaps created with the Hansatome, there was a 12.6% abrasion rate (19 patients out of 150).

Dr. Jabbur added that the abrasion rate could be directly correlated with age. She said the average age of patients with abrasion was 49.3 years, while those with no abrasions had an average age of 42.9 years. The difference was statistically significant, she said.

LASIK, LASEK, PRK

In a 300-patient study that compared LASIK with laser epithelial keratomileusis (LASEK), “selecting LASEK does not appear justified” based solely on differences in postoperative dry eye, according to Robert Lingua, MD.

Dr. Lingua said more than 70% of patients experienced tear insufficiency to some degree with either LASIK or LASEK. But he added that the patients who had undergone LASEK reported only slightly fewer dry eye symptoms.

In a separate study, eyes undergoing photorefractive keratectomy experienced less intraoperative and postoperative pain than eyes undergoing LASEK.

The randomized, double-blind study of 40 patients was described in a poster authored by Eui R. Chung, MD, and colleagues.

Forty patients requiring refractive surgery on both eyes were randomized into two groups. Half of the patients received PRK in one eye before LASEK in the other eye. The other group received LASEK before PRK. One surgeon performed all the refractive procedures.

Pain was assessed using an analog scale of no pain (0) to worst pain imaginable (10) during surgery and postoperatively on days 1, 2 and 6.

Eyes that underwent PRK registered an average pain level of 3.61 intraoperatively, compared with 3.89 in the LASEK eyes. On postoperative day 1, PRK eyes averaged a pain level of 3.29, compared with 5.46 in LASEK eyes, the highest amount of pain experienced among all patients under the study parameters. During all points in the follow-up period, pain scores were significantly lower in the PRK group.

The ASCRS poster judging committee awarded this poster honorable mention in the category of Best Refractive Poster.

Array vs. LASIK

Patients implanted with the Allergan Array multifocal IOL for correction of presbyopia achieved better visual outcomes than patients who underwent LASIK, according to Michael Woodcock, MD.

He compared 19 patients who underwent presbyopic lens exchange (PRELEX) with the Array to patients who underwent LASIK. Patients underwent either LASIK according to CRS protocol with the Summit or Visx excimer laser or PRELEX with the Array IOL. Minimum follow-up for the Array was 2 weeks and minimum follow-up for LASIK was 6 months.

All 19 patients who received the Array had best-corrected visual acuities of 20/40 or better distance and J3 or better near. Dr. Woodcock said the Array provided “excellent” predictability in refractive outcomes, with 89% of patients within 0.5 D of their target refraction and all patients within 1 D of target refraction.

“PRELEX with the Array is both safe and effective for hyperopia and presbyopia,” Dr. Woodcock said. He noted that his study involved an off-label use of the Array lens.

Microkeratome news

CIBA Vision Surgical announced here that the company will market a device called a subepithelial separator (SES) for use in LASEK.

The microkeratome-based device, designed by Ioannis Pallikaris, MD, has a suction ring that creates an epithelial flap for sub-epithelial LASIK surgery, a variation on LASEK. The device eliminates the need for alcohol in separating the epithelium from the basement membrane, CIBA officials said. Because alcohol is toxic to epithelial cells, removing the alcohol application from the procedure results in faster healing and less pain for patients, they said.

The separator delaminates the epithelium, thereby reducing LASIK flap complications.

Although the SES is currently not available in the United States, CIBA Vision plans to market the product globally early next year.

Another microkeratome, recently purchased by Paradigm Medical Industries, was described as “awesome” by a surgeon involved in its development

“The psychology of the way it was designed is awesome,” said J. Charles Casebeer, MD.

Paradigm recently purchased Innovative Optics, original manufacturer of the Innovatome. The device is now known as the K-tome. Dr. Casebeer, former president of Innovative Optics, now serves as a consultant to Paradigm Medical. Dr. Casebeer and Paradigm Medical officials discussed the merits of the K-tome at a press conference here.

While the surgeon is using the device, “you always see the surgical field,” Dr. Casebeer said. He added that the K-tome creates a smoother stromal bed than other microkeratomes.

Company officials said about 500,000 eyes had undergone LASIK with the K-tome since the device was developed in the early 1990s. Dr. Casebeer said nearly 200 systems have been sold worldwide. The K-tome is the most widely owned microkeratome in Korea, he said.

The console sells for $52,950, according to Yari Mitchell, surgical product manager for Paradigm Medical. Blades are available for $60 each.

Cornea and miscellany

Dry eye emulsion coming

Allergan plans to launch a new dry eye treatment in September, according to company officials here.

Refresh Endura is an emulsion eye drop that treats all three layers of the tear film, according to Joe Vehige, OD, senior director and therapeutic area head of consumer eye care research and development for Allergan. Dr. Vehige said this oil-based formula provides immediate and long-lasting relief of persistent dry eye and also enhances and stabilizes tears. Refresh Endura quickly dissipates into the tear film, is non-comedogenic and results in minimal blurring, burning and itching, he said.

Dr. Vehige said patients treated with Refresh Endura in a 90-day study showed a decline in symptoms by day 7.

“It doesn’t take a dose of therapy for 1 month to get a response,” he said during a press conference here.

Company officials said Allergan will also begin developing a preserved version of Endura soon. Allergan launched Refresh Liquigel in November 2001.

Hall of Fame

Four new members were inducted into the ASCRS Ophthalmology Hall of Fame at this year’s meeting.

Begun in 1995, the Hall honors ophthalmologists living and dead who have contributed to the advancement of the field.

The four inductees were celebrated with short videos recounting their contributions to ophthalmology. The two living recipients were there to accept their honors in person.

Bernard Becker, MD, was head of ophthalmology at Washington University. Known for his research in glaucoma, he was also one of a group of ophthalmologists that was instrumental in convincing the government to found the National Eye Institute.

Arnall Patz, MD, was head of the Wilmer Eye Institute at Johns Hopkins University. His best known contribution was the discovery that excess oxygen had a bad effect on retinopathy of prematurity. He also was an early investigator of the argon laser for diabetic retinopathy.

Posthumous awards went to Edward Norton, of the University of Miami, and to Jules Gonin, of Lausanne, Switzerland, the father of modern retinal surgery.

The awards were presented at the ASCRS opening session.

Film Festival

Heriberto Marotta, MD, of Argentina won the ASCRS Film Festival Grand Prize. He received his award at a gala ceremony here.

His film, “Epithelial ingrowth: how to treat and prevent,” was recognized from among hundreds of submissions.

Other winners include the following:

Cataract Complication Management category: First Place: “It’s not (just) how you see, it’s how you look,” by Michael Snyder, MD, of Cincinnati; Runner-up: “Bits in Berger’s space,” by Brian Little, MD, of England.

Cataract/Implant Surgery category: First Place: “Capsular fragility: iatrogenic or inherent,” by Robert Osher, MD, of Cincinnati; Runner-Up: “Tangential hydrodissection,” by John Hart Jr., MD, of West Bloomfield, Mich.

In-House Productions category: First Place: “Snowflake opacification: a late PMMA surprise,” by Fernando Trindade, MD, of Brazil; Runner-up: “New phacoemulsification modalities,” I. Howard Fine, MD, of Eugene, Ore.

Instruments/Devices category: First Place: “Intimacies of phaco tip operation,” by Jaime Zacharias, MD, of Chile; Runner-up: “The idea of the Carriazo pendular,” by Raif Gerl, of Germany.

Intraocular Lenses category: First Place: “Evaluation of a light adjustable lens in the rabbit model,” by Nick Mamalis, MD, of Salt Lake City; Runner-up: “Intraocular lens opacification, opacification, opacification,” by Suresh Pandey, MD, of Charleston, S.C.

New Techniques category: First Place: New techniques in capsular irrigation,” by Anthony Maloof, MD, of Australia; Runner-up: New solution to leukocoria,” by Wendy Falzoni, MD, of Brazil.

Quality Teaching category: First Place:” Exploring Schlemm’s canal,” by Anil Mandal, MD, of India; Runner-up: “Horizontal versus vertical chop: analysis of technique,” by Ike Ahmed, MD, of Canada.

Refractive Complication Management category: First Place: Lamellar keratoplasty after LASIK complication,” by Jamie Aramberri, MD, of Spain; Runner-up: “Mycobacterium warnings,” by Luis Rodriguez, MD, of Venezuela.

Refractive Surgery category: First Place: Wavefront changes during accommodation,” by Lars Frisch, MD, of Germany; Runner-up: “The IOL that moves,” by Manfred Tetz, MD, of Germany.

Special Interest category: First Place: “Velocity subsonic,” by William Fishkind, MD, of Tucson, Ariz.; Runner-up: “Anterior capsule splitting structure and Wieger’s ligament revealed by visco-ICG staining,” by Yoshifumi Fujita, MD, of Japan.