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In search of better surgical outcomes at the American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting.
When Outpatient Surgery Magazine invited me to walk the exhibit hall at the American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting in San Diego, Calif., in search of the latest product advances for better surgical outcomes, I gladly accepted. Every year, I enjoy attending ASCRS to catch a glimpse of the state-of-the-art in our industry and, just as importantly, what's to come. Cataract procedures are the most common surgeries in America. While the vast majority of these surgeries are executed successfully, that certainly doesn't mean we can't improve the vision, outcomes and quality of life for our patients. Here are my impressions of some of the many products that stood out on my tour of the floor and can help your eye surgeons do just that. OSM
EYES WIDE OPEN Dr. Bailey views a video on administration of Dexycu (dexamethasone intraocular suspension) 9%, an intraocular steroid for the treatment of post-op inflammation.
| Joe Paone
All cataract surgeons would like to use intracameral antibiotics to fight post-operative infection after cataract surgery. Two recently approved products could potentially eliminate the compliance issues associated with the complicated steroid
eye drop regimen following cataract surgery.
Dexycu (dexamethasone intraocular suspension) 9%, the first FDA-approved intraocular steroid for the treatment of post-op inflammation, is a great example of how we can reduce the drop burden for a patient. This is a steroid that's injected
through a single shot into the posterior chamber at the end of cataract surgery. The sustained-release drug dissolves over the course of a month.
Dextenza (dexamethasone ophthalmic insert 0.4 mg) is FDA-approved to treat both post-operative inflammation and pain. It is an intracanalicular insert that is placed in the lower punctum following cataract surgery. It is designed to deliver
a steroid to the ocular surface for 30 days following insertion.
RELIEVING PRESSURE Dr. Bailey gets hands-on with iStent inject.
| Joe Paone
Traditional glaucoma surgeries are effective, but they are also highly invasive, carry risks and have long recovery periods. However, we're now able to treat some forms of mild-to-moderate primary open-angle glaucoma (POAG) during cataract surgery
through the use of Micro-Invasive Glaucoma Surgery (MIGS). The goal of MIGS is to lower intraocular pressure (IOP) with a less invasive and safer method than implanting a drainage device or performing a trabeculectomy. MIGS is not used for
advanced glaucoma, but it's good for a lot of patients I take care of who are on drops for glaucoma and are presenting for cataract surgery. We continue to see evolution and new products in this area.
Within the past year, the FDA has approved 2 MIGS stents that go into Schlemm's canal, the drainage system of the eye, and expand its width. As a result, these canal-based trabecular microbypass stents — Ivantis's Hydrus Microstent and Glaukos's
iStent inject — improve the outflow of aqueous fluid in order to reduce IOP, supplementing the IOP relief provided by the concurrent cataract surgery. After the stent is implanted, I monitor the patient's IOP to make sure it's working
properly.
The first generation of the iStent works well, but has a steep learning curve and can be technically challenging to insert. Getting the right angle and depth of insertion can be difficult. With the second generation, iStent Inject, you implant
2 devices, potentially getting more IOP lowering. I have found them easier to insert as well.
A NEW VIEW Dr. Bailey dons 3D glasses to take a spin with Alcon's new visualization system.
| Joe Paone
The microscopes in use nowadays are all very good, but the 3D visualization provided by this system gives you even greater depth of focus. It consists of a 3D stereoscopic high-definition digital video camera and workstation that acts as an adjunct
to the microscope during surgery. Now, for me, this is as much a teaching tool — it lets everyone in the OR see what you're seeing — as it is a tool that you need specifically for surgery. Clinically, it's not a must-have. But it's
certainly a nice-to-have if you can afford it. Beyond the image quality, the big benefit of systems like this is surgeon ergonomics. Traditionally, when you're sitting at a microscope, you're hunched over, looking down. After years and years,
that can take a toll. There are times when my back screams at me at the end of the day. A lot of that is just paying attention to your posture when you're doing cases, but you don't always do that. This scope allows you to assume a different
posture so that you're looking straight ahead, which is ergonomically much, much better.
WHAT I SAW AT ASCRS
Digitally Connected Eye Surgery
A recurring theme at ASCRS, as with many other surgical disciplines at their own recent trade shows, was the incorporation of digital connectivity into the surgical process. This wave of new products provides surgeons with more real-time data
and assistance than most could ever have imagined 20 years ago, allowing them to be better prepared to plan and execute ophthalmic surgeries. Let's take a look at some of these products, and other innovations we saw on the floor.
— Joe Paone
Bausch + Lomb eyetelligence Applications bausch.com These cloud-based apps add power to Bausch's Stellaris Elite phacoemulsification platform, which combines cataract and retina capabilities. The idea is to
use IBM's Watson Internet of Things (IoT) services through its cloud-based infrastructure to enable surgeons and centers to work more efficiently. What's that mean? Users enjoy expedited technical support and can synchronize preferred
surgical settings across multiple Stellaris Elite systems at multiple sites. Bausch adds that the cloud gives it a centralized view of operational and performance data from Stellaris Elite systems in the field throughout the country,
so it can pinpoint and respond to technical and service requests promptly, as well as identify and address system conditions to limit downtime. Surgeons can grant Bausch remote access to their Stellaris Elite system through the
cloud to allow the company to perform technical assessments and issue software updates.
Zeiss Artevo 800 zeiss.com/meditec Billed as "the first digital microscope in ophthalmic surgery," Artevo 800 provides increased certainty for surgeons thanks to its dual-camera 4K
3D resolution, says the company. Its DigitalOptics feature is said to provide superior depth of field and real color impression while reducing the light intensity required in the procedure room. As a cloud-enabled device, it can furnish
real-time digital assistance and detailed information in the OR — such as intraoperative OCT imaging, cataract assistance functions, phaco vitrectomy values and patient identification — and can connect to the Zeiss Cataract
Suite, which enables surgeons to access patient data remotely.
Swiss Advanced Vision (SAV-IOL) R-TASC sav-iol.com Swiss Advanced Vision (SAV-IOL), the Swiss manufacturer of innovative intraocular lenses, discussed its project to develop an active lens with real-time autofocus
and wireless connectivity, termed Real-Time Autofocus Servo Control, or R-TASC. Still in the research and fundraising phase, the lens would fully restore accommodative function using a solar energy capture system paired with a varifocal
lens to allow real-time focus adjustment on any object the patient views, solving the lack of accommodation reflex common to other IOLs.
The R-TASC would be fitted alongside an implanted monofocal lens for distance vision, or added to patients who already have a monofocal lens but want to restore their visual accommodation. The R-TASC would be placed in the ante
rior
chamber, sitting between the cornea and the iris, as a complement to the eye's natural lens rather than a replacement for it, says the company.
SAV-IOL already offers an EDOF (Extended Depth of Focus) IOL, Harmonis, that's customizable via a "try before you buy"-style online configurator that surgeons and patients can explore together to find the optimal vision configuration before
the lens is ordered.
Sight Sciences OMNI Surgical System omnisurgical.com The "next generation" of this manually operated device incorporates feedback from the field to deliver improved device preparation, aesthetics, handling
and ergonomics, says the company. Its dual functions are titratable trabeculotomy and transluminal viscoelastic delivery. Surgeons can target all 3 sources of resistance in the conventional outflow pathway —trabecular meshwork,
Schlemm's canal, and distal collector channels — with the device in a single surgery. It delivers small amounts of viscoelastic fluid through a custom microcatheter, and can also cut trabecular meshwork tissue during trabeculotomy
procedures. One caveat: It shouldn't be used in cases where there's insufficient visualization of the anterior chamber. OSM
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