OSN New York’s 11th year a success

Issue: October 15, 2002

NEW YORK — Nearly 400 physicians and exhibitors attended the Eleventh Annual Ocular Surgery News New York Symposium on Cataract, Glaucoma, Retina and Refractive Surgery.

Last year’s symposium was cancelled due to the tragedies of Sept. 11, but attendees returned this year to attend the meeting and the special section on retina.

“I think it is wonderful that New York is back and vibrant. The shows are full, the restaurants are full, and this meeting is back to slightly greater attendance than we had 2 years ago,” said Richard L. Lindstrom, MD, Meeting Course Director and Ocular Surgery News Chief Medical Editor. “I think that is what New Yorkers want, Americans want — for us to get back to business and prosperity.”

Jason S. Slakter, MD, presented interim 6-month results of two trials in which anecortave acetate is being evaluated for use in choroidal neovascularization (CNV). He found that a single treatment of anecortave acetate 15 mg was statistically superior to placebo treatment for maintenance of vision and inhibition of lesion growth, according to interim results of a study.

Dr. Slakter said a second study shows a “trend” favoring the combination of a single treatment of anecortave acetate with photodynamic therapy over PDT alone for maintenance of vision and inhibition of lesion growth at the 6-month follow-up point.

Dr. Slakter said that when the 6-month data were compared from these two studies, there was “no apparent clinical advantage” in the use of PDT followed by anecortave acetate over anecortave acetate treatment alone. A phase 3 trial has been initiated to compare the clinical efficacy of anecortave acetate 15 mg to PDT in patients with predominantly classic subfoveal choroidal neovascularization, Dr. Slakter said.

Implantable miniature telescope may benefit low-vision patients

A biocompatible miniature telescope implanted in the bag can create a wider visual field, high magnification, good contrast and resolution for low-vision patients, according to Stephen S. Lane, MD. He said that most low-vision aids create a limited field of view and are in convenient, unattractive and cumbersome.

Dr. Lane reported on a phase 1 evaluation of the Implantable Miniaturized Telescope (IMT, VisionCare Ltd.). Fifteen patients were included. The IMT was implanted in 14 patients; one patient had a ruptured capsule and vitreous loss. Fourteen patients were available for 6-month exam, and 12 patients were available for 12-month exam. (One patient died, and one was not available.)

In best corrected distance visual acuity at 6 months, seven patients gained 2 or more lines from baseline, three gained 1 line and four gained less than 1 complete line change from baseline. No patients lost one or more lines. At 12 months, seven patients gained two or more lines, four gained 1 line and one gained less than 1 complete line change. None lost 1 or more lines.

For best corrected near visual acuity at 6 and 12 months, 6 patients gained 2 or more lines, 2 gained 1 line and 2 gained less than 1 complete line change. Two patients lost 1 line, and two lost 2 or more lines. At 12 months, six gained 2 or more lines, one gained 1 line and four had less than 1 complete line change. One patient lost 1 line, and none lost 2 or more lines.

Post-LASIK dry eye, use tears ‘whether you need them or not’

On the refractive surgery front, Kerry D. Solomon, MD, presented a study on post-LASIK dry eye. Results found that LASIK patients who used artificial tears regularly 4 to 6 times per day for up to 3 months postoperatively experienced a reduction in dry eye symptoms.

“We should be giving our patients drops 4 to 6 times per day whether they need them or not,” Dr. Solomon said.

In a study, 80 patients who underwent LASIK for myopia were given artificial tears or saline solution. One group was asked to administer artificial tears 6 times per day on a set schedule. The other group was asked to administer saline solution as needed for pain, blur, light sensitivity or night driving.

Results found that patients administering drops on the strict schedule had fewer dry-eye symptoms and were more comfortable than patients who administered the drops on an as-needed basis.

CK effective for monovision in presbyopia

Conductive keratoplasty can be effective for inducing monovision in presbyopia patients, according to one surgeon.

Louis Nichamin, MD, said the procedure is safe, and patients are satisfied.

In a study of 45 patients corrected using this technique, 79% had binocular near uncorrected visual acuity (UCVA) of J2 or better at 6 months postoperatively; 72% had binocular best corrected visual acuity of 20/20 or better and J2 or better; and 95% had binocular UCVA of 20/40 or better and J3 or better.

The study also examined patient satisfaction. At 1 month postop, 86% of patients were very satisfied or satisfied with their vision, 8% were neutral and 6% were dissatisfied. At month 3, 80% were very satisfied or satisfied, 16% were neutral and 4% were dissatisfied. At 6 months, 75% of patients were very satisfied or satisfied, 20% were neutral and 5% were dissatisfied.

Accommodative dual-IOL technique shows promise for presbyopes

A technique that uses two IOLs to achieve pseudoaccommodation is showing promise for presbyopes, according to Raymond Stein, MD. The term “DualFlex” is Dr. Stein’s own term for a technique he invented that employs two standard IOLs from STAAR Surgical, the Elastic and the Elastamide.

The technique was developed for use with clear lensectomy in hyperopic patients. Two lenses are inserted. A plate-haptic IOL, inserted in the capsular bag, makes up two-thirds of the total lens power. A three-piece silicone IOL, inserted in the sulcus, makes up the remaining one-third of the lens power. Dr. Stein said this technique improves both distance and near vision.

The double-lens technique was used in 24 eyes of 13 patients. Mean patient age was 53 years. Average preoperative spherical equivalent was +8.6 D, and average follow-up was 13 months. Fifteen of 24 eyes (63%) were 20/40 or better uncorrected for distance, and 83% had J4 or better uncorrected near vision, Dr. Stein said. Additionally, 83% could see J4 or better and 71% could see J3 or better with distance correction in place.

None of the patients lost best corrected visual acuity, Dr. Stein said. Only one eye experienced a complication, pupillary capture.

Avoiding blurring, drowsiness are key to drop choice

Presentations also were given on glaucoma medications. In a study conducted to determine if patients would pay more for a different eye drop, patients said that reduction of blurring and reduction of drowsiness would be factors in that decision. Convenience factors and use of a brand-name medication are less important, according to the study.

“Learning what our patients want is the first step in giving them what they want,” according to Henry Jampel, MD.

Dr. Jampel and his colleagues conducted a “willingness-to-pay study,” in which they tried to ascertain if patients were willing to pay a higher copayment or more out of pocket for a different glaucoma medication. They studied 230 patients and questioned them on drop choice in regards to blurred vision; stinging/burning; bad taste; drowsiness; and inhibition of sexual function. They also studied frequency of administration; one versus two medications in one bottle; and generic versus brand name medications.

Median annual income was $41,000. Eighty-three percent of patients had some form of insurance with co-payments for prescriptions. Median education was some college.

Results found that 85% of patients were willing to pay up to $25 more for the drops if it reduced blur; 80% of patients were willing to pay more if the drop reduced drowsiness; 75% of patients were willing to pay more if it reduced bad taste; 70% would pay more if it reduced stinging or burning; and 60% would pay more if the drop helped to maintain sexual function.

On the other hand, 50% of patients would pay more if they could administer the drop one time as opposed to 3 times per day; 40% if they had two drops in 1 bottle; 35% would if they could take the drop twice versus three times per day; and 20% would pay more if they could take a brand-name drug versus a generic drug.

For Your Information:

The Twelfth Annual Ocular Surgery News New York Symposium on Cataract, Glaucoma, Retina and Refractive Surgery is scheduled for September 2003.