LA LA LAND T. Hunter Newsom, MD, headed to Hollywood to see which products and technologies generated a buzz on the show floor of the 50th American Society of Cataract and Refractive Surgery meeting.

LOS ANGELES — This year's American Society of Cataract and Refractive Surgery meeting commemorated the 50th anniversary of the invention of phacoemulsification. It was somehow fitting that a simple device designed to eliminate phaco ended up stealing the show. Here's a look at that game-changing innovation, the miLoop from IanTech, and several other hot new products that went to Hollywood in search of their big break. OSM

BACK TO THE FUTURE This pen-like tool was developed with the intention of reinventing cataract surgery.

IanTech | miLoop
Surgeons of all skill levels can use this slick micro interventional device to fragment cataracts into multiple pieces in the capsular bag without use of phaco energy. A super thin, lens-shaped nitinol loop at the end of the device can cut cataracts of any density. Surgeons insert the tool into the eye through a 1.5 mm incision, unfold the loop, encircle the lens and pull back on the device's button to "cinch" the lens in half. Surgeons then rotate the tool to initiate several other cuts, and the resulting lens fragments can be removed with aspiration alone.

MiLoop is a fundamental shift away from classic cataract surgery. Instead of chopping from the inside out like phaco, miLoop cuts from the outside in, so no pressure is applied to the capsular bag. The loop sweeps in from the periphery to polish the capsule and separate the lens from the capsular bag. IanTech has initiated a limited launch of the single-use device, which costs about $150. I've used this tool in practice and believe it has the potential to transform cataract surgery into a more efficient and cost-effective procedure.

INSIDE OUT The Allegro is available with 2.4 mm and 2.8 mm tips, so surgeons can match the instrument to the size of the incision they prefer to work through.

MST | Allegro I/A System
Unlike conventional I/A handpieces, the Allegro System is a single-piece device, meaning surgical techs don't have to assemble it before use. That's a nice time-saving perk. The aspiration port is at the far distal end, so surgeons can use the same flat-wristed hand position they use while manipulating phaco handpieces. The port also features a dual 45-degree bend, which lets surgeons use the handpiece as a 90-degree instrument for easier subincisional cortex removals. A silicon sleeve that covers the entire instrument is designed to release quickly if it comes in contact with the posterior capsule. That safety design could prevent inadvertent tears of the capsular bag. I like the ergonomics of the instrument. It's light and feels like it'd be easy to manipulate. The single-use device costs about $17 per case. That's not a bad price — depending on how many you'd need to keep up with your case volume — to eliminate having to sterilize standard I/A handpieces, which can cost upwards of $400.

GONE IN 60 SECONDS Coaxial illumination on Ellex's latest laser platform helps surgeons pulverize eye floaters in minutes.

Ellex | Tango-Reflex YAG laser
You can use this multipurpose laser to perform laser vitreolysis — the elimination of floaters from the mid- and post-vitreous. Ellex has added a few upgrades to the Tango-Reflex platform. It now features an LED light source, which provides surgeons with crisper views of the vitreous. More importantly, the laser's innovative coaxial illumination technology makes floaters easier to spot and provides added depth perception, which lets surgeons determine a floater's distance from the retina and the crystalline lens — areas that must be avoided with the laser.

Floaters are one of the most common complaints that send patients to eyecare specialists, and for many years there wasn't much we could do to address the condition. This laser finally enhances our abilities to improve a patient's quality of life, and my practice purchased this platform to meet growing demand. The technology is gaining momentum, so now's the time to become the go-to facility in your area for laser vitreolysis. If you're not an early adaptor, you'll lose the first-in-market advantage and will be forced to play catch-up to competitors who recognize the growth potential of this laser treatment.

8 MILE Alcon's new IOL lets patients see better at longer distances, even at night.

Alcon | ActiveFocus IOL
A company rep says this is the only multifocal IOL on the market that has a central portion that's dedicated to distance vision and built-in features that improve contrast sensitivity, which limits the appearance of rings and halos during dim illumination situations such as night driving. That's great news for patients. Surgeons, meanwhile, want to work with IOLs that maintain effective lens position (axial stability) after they're placed in the capsular bag. If the lens moves forward after implantation, patients will be myopic. If it moves back, patients will be hyperopic. To eliminate those risks, the ActiveFocus features Stableforce haptics, which fold easily to keep the lens's optic in the intended plane when the capsular bag starts to naturally contract after surgery. A company rep says the lens is also less likely than other IOLs to rotate after implantation, a feature that would reduce residual astigmatism. I can vouch for the stability of this lens — it's by far the "stickiest" IOL I've every implanted.

GRAVITY The fluid pressure delivered to the inside of the eye by the Stellaris Elite is no longer limited by the Earth's gravitational force.

Bausch + Lomb | Stellaris Elite Phaco Machine
The first thing you'll notice about this unit is that it has a different look than the company's previous phaco machines. Its primary upgrade involves a longer air force infusion (AFI) spike, which relies on both gravity and pressure to infuse the eye during surgery. On conventional phaco machines, surgeons typically manually set the bottle of balanced salt solution (BSS) at a certain height — 100 cm to deliver more pressure into a shallow eye chamber or 50 cm if less pressure is needed — to maintain fluid equilibrium in the eye. Instead of relying solely on gravity, this machine employs adaptive fluidics, which combine precise aspiration control with predictive infusion management to maintain the eye chamber with more precision. It also automatically adjusts to the internal eye pressure to compensate for how much vacuum the surgeon applies to remove fragmented lens pieces. Those features offer huge clinical advantages, because a surgical field that gets very shallow when too much fluid leaks from the incision can get the surgeon into deep trouble.

THE HELP Lensar says its new software is designed to improve the accuracy of the operative plan on the day of surgery.

Lensar | Streamline III
Lensar's latest software upgrade lets you transfer patient data from various pre-op diagnostic platforms to the company's femtosecond laser platform with wireless connectivity or through a USB port. The Streamline III builds the treatment plan for each patient and could allow for more precise and intuitive astigmatism management. That's important, because the degree to which a surgeon can reduce post-op astigmatism directly impacts how much you can charge patients for premium vision outcomes and use of the femtosecond laser — the better the outcomes, the more you can charge. Using technology like this to enhance how we gather and manage diagnostic data could lead to more consistent and reliable refractive outcomes.

FROM DUSK TIL DAWN The Tecnis Symfony IOL was designed to eliminate nighttime vision symptoms.

Abbott Vision | Tecnis Symfony IOL
Abbott Vision has essentially taken a monofocal toric IOL for distance and added a depth of focus for improved near vision. That's a huge development. As a surgeon who promises blended vision outcomes — excellent distance vision and 80% of near vision — this is the IOL I implant most often. The Tecnis Symfony provides uncompromised distance vision, excellent intermediate vision and functional near vision with fewer competing peaks of light intensity that can cause glare and halos. The lens is also more forgiving in both spherical and cylinder misses, which lessens the risk of post-op sight symptoms — even if surgeons don't place the IOL precisely. This lens has created a new category of implant that offers the technology to deliver the best possible vision outcomes in patients who are good candidates for presbyopia correction.

THE SOCIAL NETWORK Users within the IntelleChart network can share patient information quickly and easily.

Nextech | IntelleChart Pro EMR
My practice and surgery centers trialed and rejected several EMRs before we were sold on this platform's user-friendly features. First, the interface reads like a single running page based on our clinical flow, meaning we don't have to constantly click between screens to input or review different patient information. We can also expand and close certain sections of the patient's file — like tabs in paper charts. Interconnectivity is a major barrier to maximizing the use of EMRs, so Nextech's innovative idea to build the EMR on a single database allows for seamless communication and sharing of patient data among practices and facilities that use the IntelleChart platform. That's a huge advantage as health care continues its transition to the digital age.

ALSO SEEN AT ASCRS
Products for Better, Safer Ophthalmic Surgery

Diamatrix showed off its interactive online ordering program for diamond blades. Surgeons can see virtual renderings of the knives they design based on specific handles, blade angles and incision type. Diamatrix says the web-based ordering portal is designed to consolidate the company's print catalogue into an interactive online format.

Vitreq showcased its Operio Mobile horizontal laminar airflow mobile unit, which creates a sterile environment by sending clean air over the surgical site and instruments to act as a barrier and to minimize bacteria-carrying particles at the wound. The standard for clean surgery is less than 10 colony-forming units (CFUs) per square meter; Operio Mobile guarantees less than 5 CFUs in the clean air zone, says the company.

Ocular Therapeutix presented information about post-op steroid therapy Dextenza, a hydrogel-based drug-eluting intracanalicular insert containing the corticosteroid dexamethasone. Dextenza reduces inflammation and pain after ophthalmic surgery. It's placed through the punctum into the canaliculus to deliver the drug to the ocular surface for up to 30 days.

The 4Klarity video recording and image management system from MedXChange connects to ophthalmic microscopes to let surgeons simultaneously record 4K and HD video. The system also enables live video streaming and connectivity to picture archiving and communication systems (PACS).

Med-Logics showcased CataPulse, a phaco-free cataract surgery solution that uses pulsated vacuum to dissect cataracts using a 1 mm cannula. Delivering the cannula directly to the lens material isolates the pulsated energy, resulting in a quiet anterior chamber and causing no outward pressure on the capsular bag.

Alcon's Intrepid Transformer I/A Handpiece lets surgeons easily switch from bimanual mode, which allows for easier lens positioning, to coaxial mode for improved access to the anterior cortex at a majority of the clock hours. Alcon also displayed its CyPass Micro-Stent, which surgeons implant in the supraciliary space to divert fluid with the goal of reducing intraocular pressure in patients with mild to moderate primary open-angle glaucoma at the time of cataract surgery.

Cirle's SNS 200 3D navigation system integrates with any surgical microscope to provide the benefits of surgical navigation at a cost-effective price. The system automates surgical workflow and automatically creates a surgical plan based on the surgeon's preferences.

Omeros presented clinical data that show Omidria (phenylephrine and ketorolac injection) 1% / 0.3%, which maintains pupil dilation and reduces post-op pain, consistently contributed to shorter duration of surgery compared with epinephrine in a real-world study involving 641 cataract extractions performed by 4 surgeons at a single center.

— Daniel Cook