Publication Exclusive — What happens next: Coming home from ASCRS 2015

On my journey home after a long and highly productive American Society of Cataract and Refractive Surgery meeting in San Diego in April, I was excited to know there are many new pharmacologic, surgical and diagnostic devices that will soon be available. I always have the boding “what happens next” feeling upon my return home from any of the major meetings in order to prepare either short or long term for implementation of these technologies. Below are my favorites from ASCRS this year, as I prepare for my “what happens next” moment for my practice.

IOLS

I have started to use and was excited that the Tecnis multifocal IOL portfolio has expanded to two new add powers, +3.25 and +2.75 (ZLB00 and ZKB00, respectively, Abbott Medical Optics), in addition to the already known +4.00 (ZMB00) power. These two new IOL powers have definitely allowed the premier surgeon to customize the IOL selection to the patient’s specific lifestyle needs. When placing multifocal IOL technology, I always perform corneal topography and prefer Cassini (i-Optics) to adjust for posterior astigmatism effect in planning for an optimized outcome because uncorrected astigmatism results in unhappy patients. I also perform OCT imaging of the macula to be sure there is no maculopathy such as a subclinical epiretinal membrane, which could induce further aberrations if not careful postoperatively. Lastly, my experience with multifocal IOL technology has been best with patients who have angle kappa measurements under 0.4 mm (using devices such as the Marco OPD-Scan III and the Tracey Technologies iTrace). My preliminary experience with the ZKB00 and ZLB00 technologies has been night vision paralleling that of the monofocal ZCB00.

Mitchell A. Jackson

As a panelist in one of the IOL sessions, I was able to see all the presentations on the Light Adjustable Lens (Calhoun Vision). This technology, once approved by the FDA, will finally bring patients once locked in to levels of vision far better than 20/20 and hopefully surpassing patient and doctor expectations in cataract surgery. Typically, there are two “lock-in” treatments of the IOL, and patients have to wear special UV protective glasses to avoid accidental “lock-in” too early in the postoperative period.

Refractive

Probably the most exciting news was the FDA approval of the Kamra corneal inlay (AcuFocus) during the ASCRS meeting. The Kamra inlay is indicated for intrastromal corneal implantation to improve near vision by extending the depth of focus in the nondominant eye of phakic presbyopic patients between the ages of 45 and 60 years old. Patients should have cycloplegic refractive spherical equivalent of +0.5 D to –0.75 D with less than or equal to 0.75 D of refractive cylinder, not require glasses or contact lenses for clear distance vision, and require near correction of +1 D to +2.5 D of reading add. The potential for this “holy grail” presbyopia correction for patients without cataracts will definitely be an improvement over the sacrifices involved with monovision. The safety data with this surgical technology approached that of reading glasses. I look forward to utilizing this technology in patients with prior monofocal IOLs, prior LASIK patients with presbyopia and emmetropic presbyopes. The key take-home message with this technology is placing the inlay in the nondominant eye and preferably a –0.5 D to –0.75 D spherical manifest refraction in that eye at the time of implantation.

Dry eye

The newest dry eye therapy, which is being studied in the OPUS-3 clinical trial, is topical lifitegrast 5% (Shire), a small molecule integrin antagonist that inhibits T cell inflammation by blocking lymphocyte function-associated antigen 1 and its binding to intercellular adhesion molecule-1 (ICAM-1). ICAM-1 is overexpressed in corneal and conjunctival tissues in dry eye disease, resulting in T cell activation and additional cytokine release. This drug is fast-acting and potentially complementary to Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan). This drug received expedited NDA review slated for October 2015 and could be available sooner than predicted.

Click here to read the publication exclusive, The Premium Channel, published in Ocular Surgery News U.S. Edition, June 10, 2015.