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This year's meeting of the American Academy of Ophthalmology in San Francisco was well attended and the Moscone center was as busy as ever for the subspecialty days followed by the general sessions. Advances in techniques and technology and a variety of
new products were discussed. I spoke to a number of colleagues in different subspecialties to discover what the hot topics were this year:
Cataract
While there have been improvements in
phaco and IOL technology, femtosecond laser assisted cataract surgery created the biggest buzz at this year's meeting.
Femtosecond lasers: Three companies (LensAR, LenSx, and OptiMedica) are working in this area, developing laser devices to cut the cornea and lens, in an effort to make cataract surgery safer, more precise, reproducible, and efficient.
Intraocular lens implants: The Akreos IOL from Bausch and Lomb is a new acrylic one-piece aspheric lens with 4-point fixation that fits through a 1.8mm corneal incision. Hoya's iSert preloaded IOL injection system is another aspheric lens that comes preloaded for insertion through a 2.4mm incision. Premium IOLs, specifically the Crystalens, ReSTOR +3D and Tecnis MF, continue to be a focus of discussion. Accommodating IOLs such as Lenstec's TetraFlex and Visiogen's Synchrony lenses are awaiting FDA approval. The Alcon toric IOL has enjoyed much success, and several surgeons have reported improved results by using WaveTec Vision's ORange intraoperative wavefront aberrometer to help with alignment of the lens. Similarly, this instrument seems to be quite valuable when performing limbal/corneal relaxing incisions.
Cornea
Improvements in transplant procedures, including
DSEK, DSAEK, DMEK, and the use of the femtosecond laser to cut unique graft configurations (i.e., zig-zag), continues to be at the forefront.
The other hot topic this year is collagen cross-linking with riboflavin to strengthen ectatic conditions such as keratoconus and keratectasia after
refractive surgery.
New products include: Sirion's Zirgan (topical ganciclovir gel for the treatment of herpes simplex keratitis which is less toxic to the cornea than trifluridine because it specifically targets viral DNA), Ista's Bepreve (topical bepotastine, a non-sedating, highly selective H1-receptor antagonist for the treatment of allergic conjunctivitis which improves ocular itching as well as nasal symptoms), Allergan's Acuvail (bid preservative-free ketorolac), and Bausch and Lomb's Besivance (besifloxacin, a 4
th-generation fluoroquinolone specifically developed for ophthalmic use).
The development of ocular bandages is also an interesting area of research and 2 products in this arena are BD Ophthalmics' OcuSeal and I-Therapeutix's I-Zip, which is awaiting FDA approval.
An IPL (intense pulsed light) therapy course for the treatment of posterior blepharitis was also offered this year. To date, approximately 600 patients have undergone this therapy with the DermaMed Quadra Q4 device and have experienced good results.
Retina
The two most interesting topics seem to be new developments in the treatment of AMD and RVO.
For AMD, besides research into novel pharmacologic agents, radiation treatment shows promise. NeoVista has been investigating an invasive surgical approach while Oraya is studying an external treatment and findings from these ongoing studies were presented.
For RVO, Allergan's Ozurdex and Genentech's Lucentis seem to be helpful in treating macular edema caused by this devastating condition. Newer OCT technology (i.e., spectral domain OCT) allows faster imaging of larger retinal areas with superb resolution, and accompanying software enables physicians to view pathology from numerous perspectives (i.e., 3D cube scans, en face imaging, enhanced depth imaging).
Glaucoma
Many companies are making mini shunts and bypass devices for the surgical treatment of glaucoma. These implants are either placed ab externo under a scleral flap (Optonol's Ex-PRESS shunt) or ab interno into the angle structures (Glaukos' Micro-Bypass iStent and SOLX's DeepLight Gold micro-shunt.