Eyeworld

JUNE 2019 | EYEWORLD | 41 R Contact information Name: The biggest risk with moxifloxacin in his view is that at too high a concentration, this can be endothelial cell toxic. Two ways this can be avoided are to inject a small amount of 0.1 ml or less into the eye or to make sure this is properly diluted. "From quite a bit of research, it appears that in a concentration of 500 mg per ml, which is a 10-to-1 dilution, it is safe," Dr. Lindstrom said. "But if you're using the full-strength 5,000 mg per ml, you have to appreciate that this can be toxic to the corneal endo- thelium." Dr. Lindstrom currently relies on the intracameral injection after cataract surgery without use of supplemen- tal antibiotic drops. "I'm also dropless with regard to the steroid because I inject a small amount of dexamethasone solution intracamerally," he said, adding that he does use a continued on page 42 While no FDA trial has taken place in the U.S., there's a plethora of evidence that intracameral injections are effective in forestalling postoperative cataract infection. •In Europe, the ESCRS trial comparing no drops or topical drops to intracameral cefuroxime injections or intracameral injections plus drops showed an overwhelming reduction in the risk of endophthalmitis, Dr. Donnenfeld noted. "There were approximately 14,000 patients enrolled, and there was a 5-fold reduction in endophthalmitis with use of intracameral cefuroxime," he said. •Kaiser Permanente did a study of intracameral moxifloxacin versus topical. It showed a statistically significant reduction in endophthalmitis with the injections, Dr. Lindstrom noted. •Several prospective clinical trials studied safety and efficacy of intracameral moxifloxacin in Brazil and at the Aravind Eye Center in India and highlighted the effectiveness of this approach, Dr. Lindstrom said. Studying intracameral prophylaxis D A I L Y N E W S ASCRS 2 0 1 9 A S C R S | A S OA A N N UA L M E E T I N G S a n D i e g o NOW ONLINE DAILY.EYEWORLD.ORG ASCRS DAILY NEWS S A T U R D AY, M AY 4 , 2 019 | A S C R S A S O A A N N U A L M E E T I N G by Liz Hillman EyeWorld Senior Staff Writer T he 2019 Steinert Refrac- tive Lecture at the 2019 ASCRS Refractive Day was presented by Eric Donnenfeld, MD, Rock- ville Centre, New York. Dr. Donnenfeld has published hundreds of peer-re- viewed papers, participated in more than 60 FDA clinical trials, by Liz Hillman EyeWorld Senior Staff Writer S everal presentations during the 2019 ASCRS Refractive Day covered technologies and innova- tions that could enhance premium refractive lens surgery. An automated capsulotomy device has the ability to create a precise, reproducible capsulor- hexis, but Kevin Waltz, MD, Moving premium refractive lens surgery forward Steinert Refractive Lecture seeks to correct LASIK myths and misconceptions Ocular 1 BVI 1 WHEN RELIABILITY COUNTS THE RIGHT PACK MATTERS bvimedical.com Minimize your pack-building time Expedite your OR experience CustomEyes ® your pack BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of Beaver-Visitec International, Inc. ("BVI") © 2019 BVI. 1498237-03 Visit BVI BOOTH 1206 Dextenza ® BIG TIME'I � ION VISIT BOOTH #1737 1 Sawhney AS, �arrett Bassett M, Blizzard C, inventors; Incept, LLC, assignee Drug delivery through hydrogel plugs. US patent 8,409,606 82. April 2, 2013. © 2019 Ocular Therapeutix, Inc. All rights reserved. DEXTENZA is a registered trademark of Ocular Therapeutix, Inc. I PP-US-DX-0097 FOR FULL PRESCRIBING INFORMATION VISIT DEXTENZA.COM Indianapolis, said there might be secondary, long-term benefits of such technology as well. Dr. Waltz focused his talk on Zepto (Mynosys) because it is the only device FDA-approved in the U.S., but there are other automated capsulotomy devices. Studies have shown a Zep- to-created capsulotomy has a stronger, more tear-resistant edge when compared to femtosecond laser-created and manual capsulo- tomies. Zepto has also been asso- ciated with a reduced PCO rate, which Dr. Waltz said was "totally continued on page 4 continued on page 3 Dr. Holland presents Dr. Donnenfeld (left) with the Steinert Refractive Lecture award. unexpected" and could be due to "markedly reduced fibrosis inside the capsule." Five-year data, Dr. Waltz said, suggests that with less intracapsular fibrosis you could have less phimosis long-term. With these, Dr. Waltz said there "might be some hidden ben- efits to automated capsulotomies." Nuclear disassembly with miLOOP (Carl Zeiss Meditec) can have refractive benefits, said Sean Ianchulev, MD, New York. Dr. Ianchulev described research that suggests the cen- tripetal fragmentation that avoids stretching the capsular bag (unlike traditional centrifugal phaco-chop techniques) impacts effective lens position. This benefit is in addi- tion to the reduced phaco energy delivered to the eye for nuclear disassembly. In terms of innovation of premium lenses, Robert Maloney, MD, Los Angeles, highlighted the Light Adjustable Lens (RxSight). This lens is implanted in basic cataract surgery with no LRIs, no corneal marking, no intraop- erative aberrometry, and no axis ASCRS DAILY NEWS S U N D AY, M AY 5 , 2 019 | A S C R S A S O A A N N U A L M E E T I N G Dr. Pflugfelder spoke about "The Quest for Tear Stability." Tear stability is maintained by the lacrimal functional unit. Tear instability is a common feature of all types of tear dysfunction and a defining feature of dry eye, he said. It causes inflammation, increases blinking, degrades visual function, and stimulates corneal nociceptors. He said that there are increasing therapeutic options with different mechanisms of action to improve tear stability. Dr. Pflugfelder described the inspiration behind the choice of T his year's Binkhorst Lecture was delivered by Stephen Pflugfelder, MD, Houston, during the ASCRS Opening General Session. The Binkhorst Lecture award has been given annually since 1975, said ASCRS Program Chair Edward Holland, MD, Cincinnati. "It's ASCRS' highest award." by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor T he Annual Meeting officially kicked off on Saturday morning with the ASCRS Opening General Session (OGS). Among the highlights of the session was a special presentation to Hal Kushner, MD, this year's recipient of the first ASCRS Distinguished Mem- ber Award. Ocular 1 BVI 1 WHEN RELIABILITY COUNTS THE RIGHT PACK MATTERS bvimedical.com Minimize your pack-building time Expedite your OR experience CustomEyes ® your pack BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of Beaver-Visitec International, Inc. ("BVI") © 2019 BVI. 1498237-03 Visit BVI BOOTH 1206 Binkhorst Lecture highlights 'the quest for tear stability' OGS highlights ASCRS mission, honors Distinguished Member Hal Kushner, MD Dextenza ® BIG TIME'I � ION VISIT BOOTH #1737 1 Sawhney AS, �arrett Bassett M, Blizzard C, inventors; Incept, LLC, assignee Drug delivery through hydrogel plugs. US patent 8,409,606 82. April 2, 2013. © 2019 Ocular Therapeutix, Inc. All rights reserved. DEXTENZA is a registered trademark of Ocular Therapeutix, Inc. I PP-US-DX-0097 FOR FULL PRESCRIBING INFORMATION VISIT DEXTENZA.COM Dr. Kushner speaks at the Opening General Session, where he received the ASCRS Distinguished Member Award. continued on page 3 this topic for his lecture. After being asked to give the Binkhorst Lecture, he went to the topogra- phy area in his clinic and noticed bottles of artificial tears. "I real- ized what our technicians figured out a long time ago—that a stable tear film is a big deal," he said. A stable tear film protects and smooths the corneal surface, maintains comfort and quality vision during interblink intervals, and is a key determinant of a suc- cessful outcome in vision correc- tion surgeries. "Tear instability is a sine qua non for tear dysfunction," he said. Tear instability is also a cri- terion in recent consensus dry eye definitions. Fluorescein tear breakup time remains the most common clinical test and gold standard for detection of tear instability. There is increased interest in non-inva- sive breakup methods, Dr. Pflug- felder said, because they provide a digital record, and fluoresce- in can affect tear stability. Most continued on page 4 ASCRS DAILY NEWS M O N D AY, M AY 6 , 2 019 | A S C R S A S O A A N N U A L M E E T I N G T al Raviv, MD, New York, with coach Iqbal "Ike" Ahmed, MD, Toronto, Canada, were voted by the audience as the winners of The Voice of Ophthalmology, which took place during the second part of Sunday's General Session. Season two of The Voice of Ophthalmology involved contestants sending in video auditions, which by Liz Hillman EyeWorld Senior Staff Writer by Lauren Lipuma EyeWorld Contributing Writer Team supporting intracameral antibiotics wins The Voice of Ophthalmology Become a better doctor and lecturer by making information stick Ocular 1 BVI 1 WHEN RELIABILITY COUNTS THE RIGHT PACK MATTERS bvimedical.com Minimize your pack-building time Expedite your OR experience CustomEyes ® your pack BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of Beaver-Visitec International, Inc. ("BVI") © 2019 BVI. 1498237-03 Visit BVI BOOTH 1206 Dextenza ® BIG TIME'I � ION VISIT BOOTH #1737 1 Sawhney AS, �arrett Bassett M, Blizzard C, inventors; Incept, LLC, assignee Drug delivery through hydrogel plugs. US patent 8,409,606 82. April 2, 2013. © 2019 Ocular Therapeutix, Inc. All rights reserved. DEXTENZA is a registered trademark of Ocular Therapeutix, Inc. I PP-US-DX-0097 FOR FULL PRESCRIBING INFORMATION VISIT DEXTENZA.COM A ny speaker can make his or her message stick in an audience's mind by adding emotion, prioritizing meaning, and dividing the infor- mation into discrete chunks. That was the message continued on page 4 Dr. Raviv (right) celebrates his win of the second season of The Voice of Ophthalmology with his coach, Dr. Ahmed. John Medina, PhD, gave to at- tendees at the ASCRS Lecture on Science, Medicine and Technology. Dr. Medina is a developmental molecular biologist, researcher, and professor at the University of Washington School of Medicine in Seattle. He is also a New York Times bestselling author and considered to be one of the most engaging and crowd-pleasing speakers in the world of neuroscience. In this inspiring and exciting lecture, Dr. Medina described to attendees several principles of cognitive neuroscience that can help physicians grab and keep the attention of an audience, whether they are lecturing to a room full of people or having a one-on-one chat with a patient. Keeping the audience's attention will make the information stick and ensure the audience remembers it later, Dr. Medina said. Dr. Medina explained how human brains pay attention to different stimuli and presented a roadmap of how physicians can apply these principles to everyday communication situations, like giv- ing a lecture to a group of medical students or having a private chat with a patient. The power of emotion Holding a person's attention is vital for physicians because failing continued on page 3 ASCRS DAILY NEWS T U E S D AY, M AY 7, 2 019 | A S C R S A S O A A N N U A L M E E T I N G by Liz Hillman EyeWorld Senior Staff Writer R on Kurtz, MD, Aliso Viejo, California, deliv- ered the 2019 Charles D. Kelman Innovator's Lecture, taking attendees through the process of collaborative innovation. Ann Kelman, wife of the late Dr. Kelman, introduced Dr. Kurtz as a "true entrepreneur and collabora- tor extraordinaire." by Liz Hillman EyeWorld Senior Staff Writer Kelman Innovator's Lecture emphasizes importance of collaboration Keeping an eye on innovation Ocular 1 BVI 1 WHEN RELIABILITY COUNTS THE RIGHT PACK MATTERS bvimedical.com Minimize your pack-building time Expedite your OR experience CustomEyes ® your pack BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of Beaver-Visitec International, Inc. ("BVI") © 2019 BVI. 1498237-03 Visit BVI BOOTH 1206 Dextenza ® BIG TIME'I � ION VISIT BOOTH #1737 1 Sawhney AS, �arrett Bassett M, Blizzard C, inventors; Incept, LLC, assignee Drug delivery through hydrogel plugs. US patent 8,409,606 82. April 2, 2013. © 2019 Ocular Therapeutix, Inc. All rights reserved. DEXTENZA is a registered trademark of Ocular Therapeutix, Inc. I PP-US-DX-0097 FOR FULL PRESCRIBING INFORMATION VISIT DEXTENZA.COM M onday's Innovators General Session gave attendees a look at several advances coming down that pike, as well as a little bit of history. continued on page 4 continued on page 3 Patrick Riedel, MD, Min- neapolis, described a new place to shunt aqueous: the ocular surface. The Beacon Aqueous Microshunt (MicroOptix)—the brain child of David Brown, MD, 20 years in development—is 3.1 mm in length with an external flange width of 7 mm. It is implanted into a paracentesis-like incision, allowing aqueous to flow through a central channel. Mitigation against retrograde flow of pathogens would be a concern for such an idea. How- ever, Dr. Riedel said that this is prevented 1) by shear stress and 2) by the polyethylene glycol material that composes the central layer of the three-layer device. Polyeth- ylene glycol is considered the gold standard of anti-biofouling materi- als. It is super hydrophilic, and it prevents adherence of protein and bacteria to the channel wall, Dr. Riedel explained. In a porcine animal model followed to 6 months, Dr. Riedel noted no infections and signifi- cant, persistent IOP lowering. An aggressive bacterial challenge with the device on eight animals did not result in endophthalmitis, Dr. Riedel continued. Preliminary data from an early bird study in the U.S. and E.U. has shown a mean IOP of 13 mm Hg at 6 months, compared to a base- line mean of 27 mm Hg that was medicated with no washout of patients. Eighty-seven percent of Dr. Kurtz takes attendees through the collaborative innovation process.

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