EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/227001
February 2011 2014 December 2013 What's ahead in DUOVISC® Viscoelastic System is designed to give two viscoelastic materials with different physicochemical properties that can be used differently and/or sequentially to perform specific tasks during a cataract procedure. DUOVISC® Viscoelastic System consists of VISCOAT® Ophthalmic Viscosurgical Device and PROVISC® Ophthalmic Viscosurgical Device. CAUTION: Federal law restricts this device to sale by or on the order of a physician. VISCOAT® OVD (Sodium Chondroitin Sulfate – Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: VISCOAT® OVD is indicated for use as an ophthalmic surgical aid in anterior segment procedures including cataract extraction and intraocular lens (IOL) implantation. Viscoat maintains a deep anterior chamber during anterior segment surgeries, enhances visualization during the surgical procedure, and protects the corneal endothelium and other ocular tissues. The viscoelasticity of the solution maintains the normal position of the vitreous face and prevents formation of a flat chamber during surgery. WARNINGS: Failure to follow assembly instructions or use of an alternate cannula may result in cannula detachment and potential patient injury. PRECAUTIONS: Precautions are limited to those normally associated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly purified biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material. ADVERSE REACTIONS: VISCOAT® OVD has been extremely well tolerated in human and animal studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to effect such a rise. It is therefore recommended that Viscoat be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. Do not overfill anterior chamber. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. PROVISC® OVD (Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: ProVisc® OVD is indicated for use as an ophthalmic surgical aid in the anterior segment during cataract extraction and intraocular lens (IOL) implantation. Ophthalmic viscoelastics serve to maintain a deep anterior chamber during anterior segment surgery allowing reduced trauma to the corneal endothelium and surrounding ocular tissues. They help push back the vitreous face and prevent formation of a flat chamber during surgery. PRECAUTIONS: Postoperative increases in intraocular pressure have been reported with sodium hyaluronate products. The IOP should be carefully monitored and appropriate therapy instituted if significant increases should occur. It is recommended that PROVISC® OVD be removed by irrigation and/or aspiration at the close of surgery. Do not overfill anterior chamber. Although sodium hyaluronate is a highly purified biological polymer, the physician should be aware of the potential allergic risks inherent in the use of any biological material; care should be used in patients with hypersensitivity to any components in this material. Cannula assembly instructions should be followed to prevent patient injury. ADVERSE REACTIONS: Postoperative inflammatory reactions such as hypopyon and iritis have been reported with the use of ophthalmic viscoelastics, as well as incidents of corneal edema, corneal decompensation, and a transient rise in intraocular pressure. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. © 2013 Novartis 1/13 VIS13003JAD-PI Will continued from page 37 intraocular work, and then returned to postop, all in the same chair. "It's quite easy to do every step choreographed around laser cataract surgery," he said. With several platforms available (and some approved for more indications than others), "surgeons have to do their homework to determine which choice is the best for their practice," Dr. Rivera said. What makes the case Whenever technology is brought into a practice, "it has to make it easier for you, better for the patient, and profitable enough that you can justify it in your financials," Dr. Rivera said. "From the patient perspective, they need to feel that if they're paying extra it's a worthwhile investment on their part." If a surgeon isn't convinced about the merits of the technology, the investment won't be recouped, he said. "Once surgeons get the femto into their hands, they're going to see consistently delivered results." For physicians who are debating the purchase, "bear in mind that for patients, it brings a lot of confidence. They already know cataract surgery is quite successful. They also know traditional cataract surgery is very dependent on their surgeon's hands. But when we can add something like the laser to it that increases the precision of the procedure, that means a lot to the patient," Dr. Thompson said. For patients with Fuchs' corneal dystrophy, for instance, where the need to be as gentle as possible to the endothelium is of utmost importance, the laser reduces the amount of energy needed during the phaco portion, which reduces the stress on the eye—"so from a patient's perspective, it's a very attractive option." He believes the more surgeons learn about the technology, the more they will embrace it and want it in their own centers. Dr. Kontos said 2014 is the year of the laser, at least for his facility. He plans on having a permanent laser by the end of 2014 (and the sooner, the better). Because his practice already has a high percentage of patients interested in premium lens technology, this is one additional piece of the puzzle that's necessary. That said, he recommends people try out the platforms via Sightpath or in some other scenario to be "100% it's the way you want to go in your practice." Dr. Thompson said 2014 won't just be the year of the laser, it'll be the year of premium vision. "For me, it's all about the vision and what vision the patients want. Once they've made the decision about what type of vision they want (spectacles/no spectacles, readers only, accommodating or multifocal, etc.), then we talk about what are the best tools to help them maximize that vision," he said. The patient variable Dr. Rivera has noted an upswing in the number of people in the community who are now insisting the femto be used on them during cataract surgery; they've gotten the information online and feel well informed, he said. "The outcomes are great and patients see so well postoperatively—even those with difficult cases going in—that the word of mouth is spreading rapidly," he said. His center is still debating dedicating one surgeon to the laser and one to the OR for the remainder of the cataract procedure, but that may infringe upon surgeons' clinic times. The enthusiasm technology like the femto injects into a practice is "contagious," Dr. Thompson said. "Patients know we're doing cataract surgery with the world's best technology." As these lasers get into the hands of more surgeons, "it will many doctors are actively implementing these changes into their day-to-day routines.undoubtedly change the way we do cataract surgery," Dr. Kontos said. "Laser is changing the face of phaco, and it will move us beyond just laser cataract surgery. We'll start thinking about better ways to do cataract surgery that weren't possible before." EW Editors' note: Dr. Kontos has financial interests with Abbott Medical Optics (AMO, Santa Ana, Calif.). Dr. Rivera has financial interests with AMO. Dr. Thompson has financial interests with Alcon. Contact information Kontos: 509-928-8040, mark.kontos@empireeye.com Rivera: 801-568-0200, rpriveramd@aol.com Thompson: 605-361-3937, vance.thompson@vancethompsonvision.com ASCRS Foundation & Project Vision inaugurate third cataract surgery training center at Zhongshan Ophthalmic Center W ith an aging population of more than 1.35 billion and a cataract surgery rate (CSR) of just over 900 cataract surgeries per million population per year, China faces a devastating epidemic of cataract, said David F. Chang, MD, U.S. "You have to do 1,000 CSR just to take care of the new cases of cataract every year," he said. "If you don't, your backlog will only increase." The problem, he said, is that all the cataract surgeons had been practicing in China's major cities, while 70% of the population lives in rural farming communities. That was, until around 2004, when Dennis Lam, MD, China, then chair of the Chinese University of Hong Kong, initiated Project Vision. Built around the proverb "Give a man a fish, he eats for a day; teach a man to fish, he eats forever," Project Vision trains local eye doctors to serve the literally millions living in rural areas with no access to eyecare services. Since 2010, Project Vision has been collaborating with Dr. Chang and the ASCRS Foundation to establish four Project Vision/ASCRS Foundation Chang Cataract Surgery Training Centers in China to support Project Vision's satellite eye clinics and eye hospitals. The first two have already been established in Kunming, Yunnan, at the Yunnan Kunming Red Cross Hospital and in Shantou, Guangdong at the Joint Shantou International Eye Center. The third, located in Zhongshan Ophthalmic Center (ZOC), Sun Yat-Sen University, Guangzhou, was inaugurated on November 8, 2013, just before the 9th International Symposium of Ophthalmology (ISO). "ZOC now will play a much stronger role along with Project Vision," said Dr. Chang. "Our job is really to support them." That support comes in different ways, giving an opportunity for ASCRS members to come to the cataract training centers and teach, while providing Project Vision's trainees with some of the best cataract training resources. Among those resources is the 3D video system from TrueVision (Santa Barbara, Calif.), which was used in a phaco video workshop conducted following the inauguration.