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Sub-Bowman’s will be next trend in laser refractive surgery, surgeon predicts
Sub-Bowman’s keratomileusis could advance laser surgery beyond LASIK and PRK, while combining advantages of both procedures.
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LAS VEGAS — Sub-Bowman’s keratomileusis will become the next trend in laser refractive surgery, combining advantages of both PRK and LASIK, a surgeon speaking here predicted.
In sub-Bowman’s keratomileusis, or SBK, a femtosecond laser is used to create a corneal flap just below the level of Bowman’s membrane, at a depth of 60 µm to 70 µm, according to Daniel S. Durrie, MD.
This is “the optimal flap,” according to Dr. Durrie, OSN U.S. Edition Refractive Surgery Section Editor.
At the American Academy of Ophthalmology meeting, Dr. Durrie discussed results from a prospective, randomized, contralateral eye study comparing SBK and surface ablation in 100 eyes of 50 patients.
The IntraLase FS (IntraLase Corp.) was used to create the 60-µm to 70-µm flap, and the ablations were performed using Alcon’s LADARVision Custom Cornea excimer laser system.
Dr. Durrie used the Visante OCT to measure flap thickness at several locations and found a standard deviation of less than 5 µm at any point.
“[The cornea] is flat as pancakes,” he said. “This is important because if you go thin, you must have consistency.”
Eyes treated with the SBK procedure showed less postoperative dry eye, lower reported corneal sensitivity, similar amounts of higher-order aberrations and a higher rate of overall patient satisfaction compared to the contralateral eyes, Dr. Durrie said.
“We are now moving beyond PRK and LASIK,” Dr. Durrie said. “We will be hearing a lot about SBK.”
Other highlights from the AAO meeting are featured in the article below. Most of these items appeared originally as daily coverage from the meeting on OSNSuperSite.com. Look for more in-depth coverage of these and other topics in upcoming issues of Ocular Surgery News.
Wavefront-guided orientation of accommodative IOL improves near vision results
Using wavefront technology to determine how to orient the eyeonics crystalens accommodating IOL can slightly improve best corrected near visual acuity without affecting the quality of distance vision, according to one surgeon.
Kevin L. Waltz, OD, MD, presented data on 40 consecutive eyes, in which 20 had wavefront-guided orientation of the crystalens and 20 had random placement of the lens.
At 1 month, both groups had similar results for uncorrected distance visual acuity. However, patients in the wavefront-oriented group had significantly better uncorrected near vision, averaging J2.7 compared to J3.4 for patients in the random placement group ( P < .01), according to the study.
“The crystalens has an asymmetry,” he said. “And accommodation doesn’t decrease in a uniform fashion.” Therefore, placement of the lens should be optimized, he said.
“It appears likely that with identifying some orientation for aspheric lenses such as the crystalens, applying it to the eye along that axis, potentially we can improve near vision without hurting distance vision,” he said.
Multifocal ablation safely treats presbyopic hyperopes
Multifocal corneal ablation, also known as presby-LASIK, appears to effectively correct presbyopia and hyperopia simultaneously, according to a surgeon speaking here.
Marguerite B. McDonald, MD, discussed the outcomes of two recent studies of the procedure. A study performed by Canadian investigators included 75 eyes of 43 hyperopic presbyopic patients. The patients had preoperative sphere ranging from +1.7 D to +3.5 D and preoperative cylinder ranging from +0.43 D to +1.5 D. At 12 months after undergoing multifocal ablations, 100% of patients had achieved 20/20 or better binocular uncorrected distance vision, Dr. McDonald said.
A second study, performed by investigators in the United States, included 20 patients. Preoperatively, sphere ranged from +1.5 D to +2.5 D and cylinder ranged from +0.3 D to +1 D. At 3 months’ follow-up, 73% of patients had achieved 20/20 or better and all patients had achieved 20/25 or better in the corrected eye, she said.
No eyes lost two or more lines of best corrected visual acuity at 3 or 6 months follow-up, Dr. McDonald noted.
The results are “very reassuring because this is definitely a high wire act to create a multifocal surface over the visual axis,” she said.
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Image: Moskowitz A, OSN |
Small study demonstrates hyperopia regression after CK
Conductive keratoplasty appears effective for short-term correction of hyperopia, but the visual improvement erodes over the long-term due to regression, according to a surgeon.
Jason S. Erlich, MD, PhD, presented the results of a prospective study involving 25 eyes of 14 patients with mild-to-moderate hyperopia. All eyes had been treated using conductive keratoplasty (ViewPoint CK, Refractec Inc.), he said.
Patients had a mean baseline manifest refraction spherical equivalent (MRSE) of +1.47 D. At 12 months follow-up, mean MRSE had been corrected to +0.36 D. However, at a final mean follow-up of 55.3 months, mean MRSE had reverted back to +1.23 D, Dr. Erlich said.
“We feel that patients undergoing this treatment should be counseled that the effects might not be permanent,” he said.
The rate of hyperopia regression was higher than natural rates reported in such large-scale studies at the Blue Mountains Eye Study, Dr. Erlich noted. “I don’t think our data can be explained by progression of the patients’ hyperopia alone,” he said.
Femtosecond laser-created LASIK flaps may improve short-term visual results
Using a femtosecond laser for LASIK flap creation may speed visual recovery and improve both short-term uncorrected visual acuity and contrast sensitivity, according to one surgeon.
Steven C. Schallhorn, MD, and colleagues conducted a randomized study involving 736 eyes. Surgeons created the LASIK flap in 436 eyes using either the Hansatome (Bausch & Lomb) or the Amadeus (Advanced Medical Optics) microkeratomes and in 300 eyes with the IntraLase FS femtosecond laser (IntraLase Corp).
At 1-week follow-up, 92% of eyes with femtosecond laser-created flaps had achieved an uncorrected visual acuity of 20/20 or better, compared to 84% of eyes with microkeratome-created flaps, Dr. Schallhorn said. The difference was statistically significant and remained significant at 3 months follow-up, he noted.
Based on the results of the study as well as a previous study, Dr. Schallhorn said his center (the Naval Medical Research Center in San Diego) will begin using the femtosecond laser for all LASIK cases involving military aviators.
Femtosecond laser makes AK incisions
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Image: Moskowitz A, OSN |
A femtosecond laser can be used to create arcuate corneal incisions for the reduction of astigmatism, according to one speaker.
“Astigmatic keratotomy (AK) using the IntraLase is an effective and safe method of reducing corneal astigmatism and improving uncorrected visual acuity in a select group of eyes,” said William M. Hammonds, MD. He spoke about his results using the IntraLase FS femtosecond laser to create paired arcuate incisions for reducing astigmatism at the Refractive Surgery Subspecialty Day.
Dr. Hammond used the laser-created AK incisions in 14 eyes of 11 patients. In six eyes the astigmatism was naturally occurring, in seven it was after corneal transplant and in one the astigmatism was scar-induced.
The overall average decrease in refractive astigmatism was 4.52 D. Uncorrected visual acuity improved from a mean of 20/225 to a mean of 20/40. In the eyes with naturally occurring astigmatism, the mean UCVA was reduced from 20/250 to 20/25, he said.
Dr. Hammonds said the AK capability is available with the latest version of the IntraLase keratoplasty software.
Accommodating IOL performs well in clinical trial
The Tetraflex accommodating IOL from Lenstec is showing good results to date in a multicenter clinical trial, a speaker here said.
David C. Brown, MD, discussed interim results of the trial at the Refractive Surgery Subspecialty Day. The Tetraflex is a posterior chamber poly-HEMA accommodating IOL with a 5.75-mm optic.
In the trial, which began in September 2005, there are currently 69 eyes with 1-month follow-up. Dr. Brown presented data on 27 eyes of 27 patients with 3 months’ follow-up. He said 88% of patients can see 20/60 or better uncorrected at distance, and 94% can see 20/80 or better at near with distance correction.
“Patients do not have any complaints of dysphotopsia, glare or halos and enjoy a wide range of activities at both distance and near,” Dr. Brown said. “We’re getting 94% of our Tetraflex patients reading newsprint.”
There have been no intraoperative complications in the trial, and no incidences of capsular contraction, he noted.
Clinical results, safety led surgeon to “hang up her microkeratome”
Improved clinical results and superior safety with surface ablation procedures are the principal reasons one surgeon said she has abandoned LASIK in recent years.
Dr. McDonald, who pioneered PRK 20 years ago, outlined the reasons why she has recently returned to corneal surface ablation procedures in a presentation titled “Why I hung up my microkeratome.” It was the opening presentation here at the Refractive Surgery Subspecialty Day.
Problems experienced with surface ablation in the early days of excimer laser use in refractive surgery, such as delayed visual recovery, pain and haze, have been reduced with new advanced surface ablation techniques, such as epi-LASIK, she said.
“I’m not the only person who thinks maybe we should hang up our microkeratomes,” Dr. McDonald said. She cited data from Market Scope indicating that refractive surgeons are increasingly adopting or returning to surface ablation procedures, either completely or as a growing percentage of their overall refractive surgical mix.
Regarding safety, she said, “If you don’t have a flap, you can’t have flap complications.” A surface approach is also safer in thinner, steeper and flatter corneas, she said.
CK may be effective in presbyopes with previous LASIK
Conductive keratoplasty performed on presbyopes who have previously undergone LASIK may improve functional vision and patient satisfaction, according to Erin D. Stahl, MD.
Under an investigational device exemption from the U.S. Food and Drug Administration, Dr. Stahl and colleagues conducted a prospective, multicenter study of 44 eyes of 44 presbyopic patients who had previously undergone LASIK. The researchers used the NearVision CK procedure, performed with the Refractec ViewPoint CK device, to treat patients with eight CK spots in the nondominant eye.
At 3 months’ follow-up, near UCVA was J3 or better in 88% of patients, and 81% were within +0.5 D of intended correction. Intermediate UCVA was 20/20 or better in 86% of patients, and 76% could read newspaper print without glasses. In a satisfaction survey, 81% of patients indicated they were satisfied or very satisfied with the results.
No adverse events or flap complication were reported, and no eye lost more than two lines of BCVA at distance, Dr. Stahl said.
“We do think there is some stability and a difference between treating for hyperopia vs. treating for presbyopia,” Dr. Stahl said.
NSAID reduces pain after PRK without slowing healing
A nonsteroidal anti-inflammatory drug relieved patients’ pain after PRK without delaying epithelial healing, according to a study presented here.
Charles Reilly, MD, described the randomized study, which compared Nevanac (nepafenac 0.1%, Alcon) to placebo in patients undergoing PRK. He spoke at the Refractive Surgery Subspecialty Day.
The study included 66 adults, mean age 32, who received one drop of nepafenac in one eye and placebo in the other in a masked fashion, three times a day for 2 days after PRK. They rated their pain on a scale of 1 to 10.
Eyes receiving nepafenac were rated significantly lower on the pain scale on both days, compared to placebo. By day four patients reported no pain, Dr. Reilly said.
There was no statistically significant difference in the time to epithelial healing between the NSAID-treated and placebo-treated eyes, Dr. Reilly said, and all eyes healed within 4 days.
Cataract Surgery
Sutureless ECCE faster, more effective than phaco
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Manual, sutureless small incision extracapsular cataract extraction is more affordable than standard phacoemulsification and may be more effective in some settings, a recent study by researchers in Nepal suggests.
Geoffrey C. Tabin, MD, presented the results of a randomized study comparing the two approaches to cataract surgery in 108 patients here.
In 80% of patients who completed 1-year follow-up exams, the researchers found that 77.8% of phacoemulsification-treated patients achieved 20/60 vision compared to 90% of patients who received manual small incision sutureless extracapsular cataract extraction (ECCE), Dr. Tabin said. ECCE patients also had less edema and haze.
In addition to being more effective than phacoemulsification in developing nations, sutureless ECCE is more cost effective, Dr. Tabin added.
“Phacoemulsification is considered the standard of care for best cataract [surgery] results, but the availability and expense in obtaining the equipment for developing countries is difficult, and maintaining the equipment is difficult,” he said.
He explained that initial start-up costs of obtaining a phacoemulsification system exceed US$100,000, compared to just US$10,000 for the manual surgery approach. Per case, phacoemulsification costs US$150, while sutureless ECCE costs US$15. Also, sutureless ECCE takes on average 9 minutes to complete compared to 15 minutes for phacoemulsification, Dr. Tabin said.
“The cost is dramatically better. The safety is equivalent. The efficiency is better, considerably,” Dr. Tabin said. “We are very encouraged by our results.”
NSAID reduces CME, improves vision after cataract surgery
A nonsteroidal anti-inflammatory drug reduced the incidence of retinal thickening and improved visual outcomes in patients undergoing uncomplicated cataract surgery, according to a poster presentation here.
In a multicenter study, John Wittpenn, MD, and colleagues evaluated the effect of perioperative application of Acular LS (ketorolac tromethamine 0.4%, Allergan) plus a topical steroid, compared to steroid alone, in patients without apparent risk factors undergoing cataract surgery.
The study included 546 eyes of 546 patients randomly assigned to receive either ketorolac or placebo pre- and postoperatively. All patients also received prednisolone acetate. The presence of cystoid macular edema was assessed by the masked investigators and by a masked retina specialist who reviewed optical coherence tomography images.
The researchers found that ketorolac reduced the incidence of postop retinal thickening, which therefore improved visual outcomes.
Pediatrics/Strabismus
Surgeon: Adult strabismus surgery poses challenges
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Image: Moskowitz A, OSN |
Treating adult patients with strabismus can be challenging, but there are management options that can help improve vision. The key is remembering that the goals of adult strabismus surgery, and the surgery itself, are different from those in children with strabismus, according to a surgeon speaking here.
“Adults are different than children,” Davis B. Granet, MD, said during his presentation. “In kids, we are trying to establish binocular vision; we are trying to establish normal appearance. In adults, we are trying to restore normal appearance. We are trying to restore binocularity. ... And we are trying to expand ... visual field,” he said.
“The general ophthalmologist should never tell the adult strabismus patient that nothing can be done because, almost always, something can be done,” Dr. Granet said.
Adult strabismus can arise from numerous causes, including neurologic issues, trauma and systemic disease. Before treating, it is particularly important to understand the patient’s history, including medical history, current refractive correction and accommodative ability, he noted.
“Adults have other diseases that it is incumbent upon the ophthalmologist to identify. Those other diseases may be more important than the strabismus that brought them to you in the first place,” Dr. Granet said.
Telemedicine effective in diagnosing, managing strabismus
A recent study showed effective cooperation among physicians using Internet-based telemedicine to diagnose and manage strabismus, according to Eugene M. Helveston, MD. He presented data collected from Cyber-Sight, a telemedicine service run through Orbis International.
“Based on the current study, Cyber-Sight is probably a value to partners based on their continued use of the program,” Dr. Helveston said. “It’s probably effective for diagnosis and management of strabismus.”
Since 2003, when Cyber-Sight became a server-based operation, Dr. Helveston said Orbis physicians have reviewed 2,631 cases, of which 1,356 were strabismus. In this study, researchers examined results with three types of strabismus in which the characteristics fall easily into a clinical diagnosis. Those included 89 cases of superior oblique palsy, 131 of Duane syndrome and 50 of Brown syndrome.
When a partner physician is unsure of a diagnosis or treatment, Dr. Helveston said, a mentor is available to look at photos and data to confirm or modify the diagnosis or treatment.
The partner sends case history, patient history, refraction, visual acuity, gender and up to 17 digital images of the patient for the mentor to examine. The partner may also send an initial diagnosis and treatment plan.
Retina/Vitreous
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Image: Moskowitz A, OSN |
Anti-VEGF therapies dominate retina presentations
Drugs that inhibit vascular endothelial growth factor were the focus of a great number of retina presentations. Researchers discussed the use of this class of drugs for treating a wide range of retinal disorders, from age-related macular degeneration, where their efficacy has been established, to retinopathy of prematurity, where they are still experimental.
“About 15 years ago, when I first started reading about anti-VEGF (vascular endothelial grown factor) therapy, I would have thought for sure we would be using it in diabetes first instead of macular degeneration,” said Robert L. Avery, MD.
Since then, several anti-VEGF compounds have been evaluated for AMD and widely adopted by retinal subspecialists, and their use in other pathologies is being investigated with promising results.
Anti-VEGF drug shows promise for treating ROP
Infants with familial exudative vitreoretinopathy and retinopathy of prematurity treated with a VEGF inhibitor showed an improvement in vascular activity but a risk of tractional retinal changes, according to Kimberly A. Drenser, MD, PhD.
Dr. Drenser discussed results of the use of Macugen (pegaptanib sodium, Pfizer/OSI) in six patients with familial exudative vitreoretinopathy (FEVR) and five patients with retinopathy of prematurity (ROP).
The six eyes of the patients with FEVR received Macugen, and the five patients with retinopathy of prematurity were treated with Macugen in one eye in addition to laser treatment.
“All six [FEVR] eyes showed a remarkable reduction in exudative vascular activity within a 4-week period after the injection,” Dr. Drenser said. She added that this improvement was sustained for a number of months without toxicity.
Regarding the ROP patients, Dr. Drenser expressed concern that while there was “early impressive decrease in vascular activity” and a delay of retinal detachment, any fibrotic tissue with proliferative changes aggressively underwent tractional change.
Avastin serves as surgical adjunct in proliferative DR
Administering bevacizumab 1 week before vitrectomy in patients with complications of proliferative diabetic retinopathy may enhance the ease and success of the procedure, according to Dr. Avery.
He presented the results of a study evaluating the combined drug and surgical treatment approach in 45 eyes with progression of diabetic retinopathy despite treatment with panretinal photocoagulation. In response to surgery after treatment with Avastin (bevacizumab, Genentech/Novartis), 44 of these eyes experienced an improvement in vision, supporting the drug’s efficacy as an adjunctive therapy, he said.
The study results were published last month in Ophthalmology, he said during Retina Subspecialty Day.
“There was a rapid, biologic effect,” he said, including regression of neovascularization. “Sometimes you can even avoid going into the operating room.”
After injection of Avastin, some eyes showed a treatment response within 24 to 48 hours, but the effect varied, he said.
Procedures result in little difference from natural history of CRVO
Neither lamina cribrosa puncture nor radial optic neurotomy have shown a significant improvement over the natural history of central retinal vein occlusion (CRVO), according to Donald D’Amico, MD.
“I have stopped performing lamina puncture and recommend that radial optic neurotomy (RON) be abandoned,” he said.
Dr. D’Amico, who holds a patent for the lamina puncture blade, explained that the visual acuity outcome of patients diagnosed with CRVO mainly depends upon their visual acuity when diagnosed; two-thirds of those with good visual acuity are likely to maintain it.
In a study of 20 patients who underwent lamina puncture, only four patients improved beyond their initial 20/200 visual acuity, he said, and 3.5 would have been expected to improve with the natural history of CRVO.
Spectral OCT, wide-field angiography touted as imaging advancements
Wide-field angiography and spectral-domain OCT were touted by one ophthalmologist as great advances in retinal imaging.
“[Wide-field angiography] does seem to be ... a good tool to achieve better assessment of peripheral fundus perfusion in diabetic retinopathy and retinal vein occlusion,” said Carmen A. Puliafito, MD, MBA. He noted that the technology is a “work in progress” that shows promise for analyzing a larger portion of the retina.
Using the imaging technique, retinal specialists can view an entire sector and enlarge specific areas to see them in greater detail, he said.
Spectral-domain OCT is also a “fantastically important tool going forward,” he added.
Glaucoma
Canaloplasty shows promise as glaucoma therapy
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Image: Moskowitz A, OSN |
Canaloplasty appears to be effective in improving circumferential outflow in patients with primary open- angle glaucoma, according to a surgeon speaking here.
Richard A. Lewis, MD, used the iTrack Microcatheter (iScience) to improve outflow through Schlemm’s canal. Canaloplasty is a nonpenetrating, blebless surgical technique in which a suture is passed through Schlemm’s canal with the help of a microcatheter and tied with a small amount of tension to reopen the canal, Dr. Lewis explained.
After the initial challenge of locating the canal, which Dr. Lewis said can be alleviated with some instruction, the surgeon inserts the iTrack device into the eye and uses a viscoelastic to dilate the entire 360· of the canal. The tube is then navigated through the canal, which is facilitated by a lighted, flashing beacon mounted on the end of the microcatheter.
Once canalization is complete, a suture is threaded through the canal and tied off, Dr. Lewis said.
“I think this procedure provides an interesting and unique opportunity to work in a space that glaucoma surgeons have not worked in, not only to provide surgical control of glaucoma, but also to provide medical treatment as well, in a long-term example,” Dr. Lewis said.
Suprachoroidal space is good target for aqueous in glaucoma
To improve aqueous outflow in glaucoma, the suprachoroidal space provides many advantages over the subconjunctival space as a target site for aqueous diversion, according to Robert D. Fechtner, MD, FACS.
Dr. Fechtner said the subconjunctival space is a “dreadful” target for aqueous diversion, despite the popularity of trabeculectomy, because it results in poor cosmesis, a lifetime risk of endophthalmitis and an unpredictable wound-healing response. He proposed using the suprachoroidal space instead, as it is a normal route for aqueous outflow and heals more predictably.
Dr. Fechtner described results using the Solx Gold Micro-Shunt, which is designed to divert aqueous to the suprachoroidal space. In a nonrandomized study of 76 eyes with a mean preop IOP of 27.5 mm Hg, treatment with the Gold Micro-Shunt resulted in a 37% mean reduction in IOP at 24 months’ follow-up, Dr. Fechtner said.
Consider evaluating for vascular dysfunction in NTG patients
When evaluating normal tension glaucoma suspects, physicians should consider checking for a history of vasospasm or vascular disorders, Ivan Goldberg, MBBS, FRANZCO, recommended. Such vascular disorders have been linked to other conditions, and patients with such conditions are prone to other ocular disorders, including increased risk of retinal hemorrhage, he said.
“All glaucoma patients have damage that is pressure-dependent or pressure-independent. So anything we say under the banner of normal pressure glaucoma, we must also remember that this applies to patients with so-called high pressure or classic primary open-angle glaucoma,” Dr. Goldberg said.
“I think it’s helpful to think of vasospasm as vasoconstriction that is inappropriate to the metabolic needs of the tissue at that time, either because it has occurred unnecessarily or it has occurred in a prolonged fashion, when the need for vasoconstriction has passed,” he said.
Cornea/External Disease
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Image: Moskowitz A, OSN |
Cross-linking may halt hyperopia after previous refractive procedures
Collagen cross-linking with riboflavin may stop hyperopia progression in patients who have undergone radial keratotomy or laser ablative procedures, according to Brian S. Boxer Wachler, MD.
Dr. Boxer Wachler reviewed the results of a study evaluating whether corneal collagen cross-linking with riboflavin, or C3-R, can stabilize the progression of hyperopia in patients with previous refractive surgery.
The study included eight eyes of six patients that had documented progression of hyperopia after undergoing RK followed by a laser ablation procedure, either LASIK or surface ablation.
After the cross-linking procedure, hyperopia progression was halted in all eyes, Dr. Boxer Wachler said. No eye had more than a 1 D change of sphere or cylinder after the C3-R treatment, he said. There was little change in uncorrected visual acuity, best corrected visual acuity or keratometry after the treatment, he said, although corneal topography showed some steepening. No change in endothelial cell count was seen.
Keratoprosthesis effective with proper postop management
Keratoprosthesis is a viable alternative to standard penetrating keratoplasty in certain types of patients prone to repeated graft failure, according to Kathryn Colby, MD, PhD.
Dr. Colby said that postoperative care is crucial to success with the Boston K-Pro Type 1 keratoprosthesis.
“The best category by far is noninflammatory graft failures in patients who have intact tear secretions and blink mechanisms,” she said. “These patients do extremely well with the Type 1 Boston keratoprosthesis, both in terms of device retention and initial visual acuity improvement.”
In a recently published multicenter study including 141 patients, researchers found that 95% of eyes retained the device at 8.5 months follow-up, and 56% achieved visual acuity of 20/200 or better.
Ophthalmic Business
Zeiss introduces femtosecond laser platform
Carl Zeiss Meditec introduced the VisuMax femtosecond laser system for the creation of corneal flaps in refractive surgery here.
The VisuMax, integrated with the CRS Master custom ablation software and the MEL 80 excimer laser system, is designed to create an “optimized workflow” for refractive laser surgery, said Marcus Blum, MD, during a Carl Zeiss Meditec-sponsored symposium during the American Academy of Ophthalmology meeting.
A patient bed connected to both machines rotates 180° between the VisuMax and the Mel 80, allowing a smooth transition from the femtosecond to the excimer laser during refractive procedures, Dr. Blum said.
The fast transition is beneficial because no delay is needed between flap creation and ablation, he said.
“The VisuMax implements a curved surface pattern with tiny laser spots,” Dr. Blum said. “Nearly all of the bubbles disappear before the flap is opened by the surgeon. This allows the eye to be treated immediately with the excimer laser and there is no waiting time for the patient.”
Low suction pressure and the short amount of time needed to create the flap aid the overall refractive procedure, he said.
“Because suction is applied only during the actual laser treatment … and the suction unit is fully integrated into the system and it works with a low suction pressure … the patient experiences no vision loss during suction,” Dr. Blum said. “Therefore, it is possible that the patient fixates on a light inside the machine, which leads to an optimal positioning.”
Dr. Blum reported results from a study on 17 patients, with a mean age of 32 years and an average spherical equivalent of about –4 D with 0.5 D of astigmatism.
Alcon introduces once-daily allergy formulation
Alcon introduced Pataday (olopatadine 0.2%), a once-a-day formulation of Patanol (olopatadine 0.1%), to ophthalmologists here.
Although the once-daily drop is not yet commercially available, company officials said it will be in the first quarter of 2007. Pataday is formulated with double the concentration of Patanol, which is administered twice a day, but it offers the same safety profile, company officials said.
Patanol, which has been on the market for more than a decade, will still be available after Pataday is launched, officials said.
Bausch & Lomb introduces new phaco system
 Richard L. Lindstrom |
Bausch & Lomb unveiled its Stellaris phacoemulsification system for the first time here. The machine, which is pending U.S. Food and Drug Administration approval, will offer surgeons the choice of venturi or peristaltic fluidics and provides modes for both bimanual and coaxial microincision surgery, company officials said.
According to Richard L. Lindstrom, MD, the new machine offers greater “performance, control and versatility” than its predecessors. During a company-sponsored symposium, Dr. Lindstrom, the global chief medical editor of Ocular Surgery News, said another advantage of the device is that it has wireless control, which facilitates its use in the OR setting.
Endo Optiks launches 23-gauge endoscope
Endo Optiks launched a 23-gauge endoscope for its endoscopic cyclophotocoagulation (ECP) system here, according to Martin Uram, MD, MPH, the company’s founder.
The system employs the smallest endoscope in the world, Dr. Uram said, offering an alternative to the larger 20-gauge instrument.
ECP combines light endoscopy and visualized laser application to allow selective ablation of ciliary tissue for the management of IOP in glaucoma patients.
Dr. Uram said ECP combined with phacoemulsification is a safe and effective treatment for patients with both cataract and glaucoma.
Notal Vision and MSS unveil Foresee PHP
A device for the detection and monitoring of age-related macular degeneration was launched here.
The Foresee PHP, a second-generation preferential hyperacuity perimeter developed by Notal Vision, is distributed exclusively in the United States by MSS. The system offers a noninvasive eye exam that allows physicians to track changes to patients’ visual fields due to advanced AMD, according to the companies.
The new version is automated and can be operated by the patient, while maintaining a high degree of sensitivity and specificity, the companies said. It works by identifying elevations in the retinal pigment epithelium that indicate a progression to wet AMD.
Solx begins international training program
Solx Inc. has begun an international training and certification program for ophthalmologists in Europe and the Middle East. The program certifies specialists from these areas to perform procedures using Solx’s Gold Micro-Shunt products to treat glaucoma patients.
An educational symposium was held prior to the start of the AAO meeting. Led by Ike Ahmed, MD, Shlomo Melamed, MD, and Modi Goldenfeld, MD, the morning program included presentations in uveoscleral anatomy and physiology and video demonstrations of Gold Micro-Shunt implantation techniques.