New ASCRS president calls for advocacy action

SAN DIEGO – The coming year will see a strong advocacy effort to prove the value of today’s cataract surgery, according to the incoming president of the American Society of Cataract and Refractive Surgery.

Priscilla Perry Arnold, MD, who assumed the presidency of ASCRS during the group’s annual meeting here, vowed that the group would bring the message of ophthalmology’s value to legislators in Washington. She also noted that ASCRS has joined with the American Academy of Ophthalmology in the quest to support “surgery by surgeons.”

“Nothing equals the impact of personal contact with a member of Congress,” Dr. Arnold said during the meeting’s opening session.

“In the coming year, I would like to bring a special focus on research data that confirms the measurable value of modern cataract surgery, and to contrast this with the systematic devaluation which has occurred over the past decade,” she announced, to thunderous applause. “This project will be called ‘Open your eyes.’ Our patients, the general public and our legislators need to see this data.”

The opening general session kicked off a meeting that focused on refractive surgical lasers and on IOLs for cataract and refractive surgery. This article presents some of the highlights gathered by our reporters at the meeting.

Accommodative IOLs

The eyeonics Crystalens, approved last fall by the FDA, was a subject of discussion at the “hot topics” symposium. It is currently the only accommodative IOL available to U.S. surgeons.

Samuel Masket, MD, said the Crystalens holds promise, but surgeons should be wary of inflating patient expectations. Studies have shown that higher powers of the lens achieve greater levels of accommodation, and the lenses currently in use have had good results, he said.

Early experiences with another accommodative IOL, the dual-optic Synchrony IOL from Visiogen, were discussed at another session.

The Synchrony shows “good functional results and reliable refractive outcome,” according to Gerd Auffarth, MD. He presented 1- to 2-month follow-up in six patients who were implanted with the lens. The capsulorrhexis size in each eye was less than 5 mm, he said.

Results showed a mean uncorrected distance acuity of 0.61 ± 0.36 (range 0.2 to 1) and a mean best-corrected distance acuity of 0.97 ± 0.36 (range 0.4 to 1.6). The distance-corrected near acuity was an average of 0.37 ± 0.15 (range 0.2 to 0.6), according to Dr. Auffarth. “A dual-optic system may have more accommodative power” than a single-optic lens, he said.

Another posterior chamber accommodating IOL “shows promise as an effective means of providing useful accommodation following refractive lens exchange,” according to Deepak K. Chitkara, MD, FRCS, of Manchester, England. He presented early results with the Kellan LH1000 posterior chamber accommodating IOL by Lenstec.

In the study, 6-month follow-up in pseudophakic eyes showed distance-corrected near visual acuity of J3 or better in 40% of eyes and J5 or better in 60% of eyes, Dr. Chitkara said. Uncorrected distance vision was 20/40 or better in 83% of eyes and 20/25 or better in 67% of eyes, he said.

“This lens shows stability at up to 6 months,” Dr. Chitkara said. Further study is warranted, he added.

Other accommodative lenses discussed at the meeting included the 1CU from HumanOptics and the 43S from Morcher. Dr. Masket also discussed the concept of the SmartLens, a bag-filling IOL in development by Medennium.

Accommodative effect

A one-piece plate-haptic monofocal IOL demonstrated “successful accommodation” similar to an accommodating IOL in a number of patients, according to one speaker.

The STAAR Surgical plate-haptic IOL is not designed to be or marketed as an accommodative lens, but the lens showed accommodation that was “not statistically different” from results reported for the Crystalens accommodative IOL, according to Liviu Saimovici, MD, of New York.

Dr. Saimovici said 24 eyes implanted with the STAAR Surgical lens were examined for near vision with their best distance correction in place. He found that 25% of the eyes demonstrated near vision of 20/30 or better, and 83% of patients had near vision of 20/40 or better with distance correction in place.

Dr. Saimovici said that in four patients who received bilateral implantation, 100% had distance-corrected near acuity of 20/40 or better when tested bilaterally.

IOLs in infants

Acrylic IOLs can provide good results in infants with congenital cataracts, according to a group of Brazilian researchers.

Gloria Fatima Britez, MD, and colleagues in São Paulo reported on their results with acrylic IOL implantation in 15 infants in a poster presentation. The average age of the patients at the time of implantation was 9.8 months. Mean IOL power was +22.5 D. Mean final refraction was –0.72 D.

Adverse events included two cases of anterior synechia. There were seven eyes with posterior capsular opacities; two eyes needed YAG capsulotomies and five needed a secondary operation.

Acri.Smart reports

Sunita Agarwal, MD, described her experience with the ultrathin Acri.Smart IOL from German company Acri.Tec, showing that its design allows safe entry into the anterior chamber.

When the lens is folded, she said, a bubble of viscoelastic is formed between its rounded haptics. The bubble goes against the posterior capsule, preventing damage. Dr. Agarwal said the lens fits through an unenlarged incision of between 1.2 mm and 1.4 mm. It can also be implanted even if some intraoperative complications occur, such as capsular tear. In addition, she said she has observed that contrast sensitivity is not affected by the lens.

Jorge L. Alió, MD, PhD, said the Acri.Smart lenses yielded excellent visual acuity and little optical aberrations in his experience.

The lens is available with two optic sizes, the 36A (5 mm) and the 48S (6 mm). Dr. Alió said the 48S lens is more appropriate for younger patients.

The 36A lens has been redesigned to eliminate spherical aberration, to improve its effectiveness in younger patients as well, Jerome Vryghem, MD said. He said its efficacy has been assessed through a number of methods, including visual resolution, patient evaluation, contrast sensitivity and wavefront analysis.

Laser for cataract

Jack Dodick, MD, spoke about laser photolysis as an approach to microincision cataract surgery. He said the Dodick device from ARC Laser is appropriate for back-cracking and manipulating the lens. No significant heat is produced by the disposable laser probe, he said. The 4-nanosecond laser now has a new needle design and high vacuum tubing.

Surgical time for laser cataract removal is comparable to other techniques, Dr. Dodick said, but the device is best reserved for 1+ and 2+ cataracts only.

AcrySof phakic IOL

An anterior chamber phakic IOL made of a hydrophobic acrylic material is providing good vision to patients in a European clinical trial. The lens, a phakic version of the Alcon AcrySof (Ft. Worth, Texas), has up to 3-year follow-up in the open-label multicenter European study, according to Joseph Colin, MD.

The AcrySof phakic IOL is an anterior chamber, angle-supported lens with a 5-mm-diameter meniscus optic, Dr. Colin said. He said 102 of the lenses have been implanted unilaterally in patients with stable high myopia and up to 2 D of astigmatism.

At 6 months follow-up, 100% of eyes achieved 20/20 or better vision with correction, Dr. Colin said, and 90% achieved 20/40 uncorrected. Almost 50% of eyes gained one line of visual acuity, he said.

At 6 months 95% of eyes are within 1 D of target refraction, and 67% are within 0.5 D, Dr. Colin said. Mean cell loss of 2.9% was reported in the study eyes, he said.

Dr. Colin said the results with the AcrySof phakic IOL to date exceed FDA guidelines for phakic IOLs. He did not discuss a timeline for submission of data to the FDA.

Corneal accommodation?

Contraction of the ciliary muscle causes an increase in corneal power that may play a role in accommodation, according to a study presented by Akihiro Yasuda, MD.

In the first part of a two-part study, Dr. Yasuda and colleagues compared corneal topographies of 18 eyes of nine volunteers before and 45 minutes after the administration of topical pilocarpine. Dr. Yasuda said the researchers found a “small but statistically significant” increase in both corneal steepening and mean ring power within 45 minutes of administering pilocarpine.

In the second part of the study, Dr. Yasuda and colleagues compared the corneal topographies of two groups, each with 14 eyes of seven patients. One group received topical pilocarpine and the other received balanced salt solution. A statistically significant change was seen in the pilocarpine group, but not in the control eyes receiving balanced salt solution, he said.

Dr. Yasuda speculated that ciliary muscle contractions may aid in accommodation by exerting pressure on surrounding ocular structures, namely the scleral spur and the trabecular meshwork, which in turn may cause the cornea to steepen.