Innovation ahead

[caption id="attachment_8675" align="alignnone" width="750"] Roger F Steinert was recognised with the Charles D Kelman Lecture at the 2016 AAO Annual Meeting, for his service as an educator and innovator. David Chang (left) presented the certificate on behalf of the AAO[/caption]   Ophthalmology stands on the brink of exciting innovation, and much of it will come in cataract and refractive surgery, Roger F Steinert MD told the 2016 American Academy of Ophthalmology Annual Meeting in Chicago. A true accommodating intraocular lens (IOL) that can be inserted through a standard cataract incision, and a laser capable of correcting IOL power, spherical aberration, asphericity and multifocality in the eye after surgery are on the horizon, said Dr Steinert in the 12th annual Charles D Kelman Lecture. Dr Steinert said these technologies could be the next big innovations in cataract surgery technology. The last major developments were the introductions of foldable acrylic lenses and multifocal lenses. “We’re still behind – there are a lot of interesting innovative things we can do that are lagging behind compared with want we could be doing,” he said. BIG MARKET, SMALL PENETRATION Cataract surgery innovation has a disproportionate impact because the procedure accounts for more than half of ophthalmology practice and related industry sales, noted Dr Steinert, who was Professor of Ophthalmology and Chair Professor of Bioengineering at 
the University of California-Irvine, 
USA, and Director of the Gavin Herbert Eye Institute. Still, as of 2015, premium IOLs, including toric and presbyopia-correcting lenses, made up just 6.9% of IOLs sold, according to Market Scope data. Their impact on industry was much larger, accounting for 24% of IOL revenues and an estimated 40% of IOL earnings. “Industry drives innovation,” Dr Steinert observed. He discussed two innovative cataract surgery technologies he has been involved with that have the potential to revolutionise the field. One is the LensGen® (LensGen, Irvine, California, USA) accommodating IOL. It consists of a base with a fixed optic into which a fluid-filled lens is inserted. Slight ciliary contractions are amplified by a ring of levers mounted around the fixed optic that press on the fluid-filled lens, deforming the liquid optic. This amplification allows the very small range of motion available from the ciliary muscles to create a wide range of continuous accommodation similar to that provided by the crystalline lens, 
Dr Steinert said. The lens components can be inserted through a standard small cataract incision, and the fixed posterior optic provides a platform for astigmatism correction, he added. “It does move and this is very promising going forward.” A second innovative technology may help solve the problem of incorrect IOL power, Dr Steinert said. The Perfect Lens Perfector I (Perfect Lens, Irvine, California, USA) is a device that can change the refractive index of IOLs in the eye after surgery. It works by altering the hydrophilicity of acrylic lenses, and can be used with hydrophobic or hydrophilic IOLs. A femtosecond laser creates a phase-wrapped lens that can correct IOL power, or add or remove multifocality, Dr Steinert said. The procedure takes 10 to 20 seconds, and has changed lens power by as much as 3.6 dioptres in model, and the changes can be easily reversed. “It can work both ways and all this is done with on visible change in the lens,” he said. CORNEAL INLAY The unexpected FDA approval of the Raindrop® (ReVision Optics, Lake Forest, California, USA) near vision corneal inlay may revolutionise presbyopia correction for emmetropes, Dr Steinert said. Implanted in the centre of the cornea of the non-dominant eye, the hydrogel device promotes remodelling of the corneal epithelium, creating a profocal cornea that enhances near vision in the centre and transitions smoothly to intermediate and distance focus at the perimeter. Distance vision is lost monoculalry in the treated eye, but not affected binocularly. Patients have good binocular acuity at all distances, Dr Steinert said. The Raindrop near vision inlay is inserted under a corneal flap cut with a femtosecond laser that is centred on the light-constricted pupil. It is made of a biocompatible material with a similar refractive index and water content as the stroma, and maintains natural nutrient flow, Dr Steinert said. In US clinical trials the implant has produced 20/32 or better vision at all distances in 96% of patients, and is removable, Dr Steinert said. “This is just one of many coming innovations,” he added. The Kelman Lecture is delivered by an individual who has made significant contributions to the advancement of cataract surgery through education, innovation or scientific study. The AAO recognised Dr Steinert for his long-time commitment to cataract surgery education in academia and professional societies, as well as his work with industry on advanced devices and instruments. EuroTimes and the ESCRS wish to extend our sincere condolences to the family, friends and colleagues of Dr Steinert, 
who sadly passed away in June 2017

Tags: innovation, kelman