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EW FEATURE 41 prize in its category at the 2007 Film Festival at the annual meeting of the European Society of Cataract & Re- fractive Surgeons. The film attracted the attention of MST, which went on to manufacture the device. Dr. Malyugin had been working with versions of the ring since the year 2000. The device that Dr. Malyugin featured is placed through the main surgical incision and provides eight points of fixation, resulting in a round pupil. Dr. Malyguin experi- mented with different materials and sizes for the ring and credits the en- gineers at MST with the idea of using an injector to place the ring. "I think this was a major improvement as it made implantation easier," he said. As the name of Dr. Malyugin's film indicates, the device is particu- larly useful in patients with intraop- erative floppy iris syndrome. Upon introduction of the device to the ophthalmic market, Dr. Malyugin was pleasantly surprised by the feedback it received. "We were very lucky because we had a lot of cooperation, and people started to use this device," he said. In fact, that created its own challenge. "MST had a huge backlog, and they were not able to satisfy all the customers [who wanted] this device," Dr. Malyugin said. Surgeons using the device gave a good deal of feedback on how to fur- ther modify the product, something that Dr. Malyugin welcomed and continues to welcome. "It's exciting how knowledge of the device ex- pands; one person cannot have all the mind power that a lot of sur- geons from different countries have. A lot of bright minds have tried to use the product and have ideas on how to improve the surgery," he said. Those improvements led to the creation of a 7-mm ring, slightly larger than the 6.25-mm original de- vice. Other modifications to the ring are under consideration now, Dr. Malyugin said. Collaboration with the right team—and a quality product that helps with patient care—can help future inventors, Dr. Malyugin said. "It's important to have a company or person from a company who be- lieves in [your product] and is com- mitted to innovation and good work," he said. iStent Trabecular Micro-Bypass When inventing something new, you never know where inspiration will come from. In the case of the iStent, Richard Hill, M.D., Santa Ana, Calif., gained inspiration from a cardiologist and from Japanese his- tory. "I was at a [National Institutes of Health] grant review meeting, and a cardiologist was telling me how he had to put in a stent in his angio- plasties. As soon as he said the word 'stent,' a light went off," said Dr. Hill. Later, he was reading about the Mongols attacking the Japanese in the 1200s. "The Mongols wore thick leather armor, so when the Japanese designed daggers and swords to pen- etrate the armor, they used an an- gled point," Dr. Hill said. That gave him another idea about the angled design of the stent. The iStent is used during cataract surgery to reduce IOP in pa- tients with mild to moderate open- angle glaucoma. "The device is a heparin-coated, non-ferromagnetic, surgical grade, titanium stent that is approximately 1 mm in length and 0.3 mm in height, 1/20,000 of the size of the Baerveldt implant [Abbott Medical Optics, Santa Ana, Calif.]," according to the Glaukos website. It wasn't until Dr. Hill was per- forming a trabeculectomy on the son of a venture capitalist that the idea for the iStent was brought to full fruition. "His basic question was whether there is something better than a trabeculectomy for glaucoma patients," Dr. Hill said. "I said that I had some ideas." That led to a collaboration and the formation of the company Glaukos as well as improvements on the iStent idea, including the cre- ation of an inserter. "The rest is his- tory—hopefully good history." February 2011 November 2011 Innovation in ophthalmology Poll Size: 459 EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a monthly reader pulse on trends and patterns for the practicing ophthalmologist. Each month we send a short 4-6 question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email: ksalerni@eyeworld.org and put EW Pulse in the subject line; that's all it takes. Copyright EyeWorld 2011 The Malyugin Ring in a tamsulosin patient with intraoperative floppy iris syndrome Source: David F. Chang, M.D. continued on page 43

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