Eyeworld

EW FEATURE 31 T he U.S. has long been known for its innovation in ophthalmology, but the lack of availability of ad- vanced IOLs here means the premium lens market seems to be lagging behind its European counterparts. Surgeons who spoke to EyeWorld agreed that fewer lenses here puts surgeons at a disadvantage. "We have quite a big stock of lenses," said Tobias Neuhann, M.D., medical director, Marienplatz Eye Clinic and Opera House Cooperative Medical Care Centre, Munich, Ger- many, who has more than 30 years of experience implanting IOLs in the country. "The whole world used to go to meetings in the States because the evolution of these lenses came from the States. All the brilliant ideas still come from there, but there is the FDA. A lot of American oph- thalmologists, friends, and so-called opinion leaders hate to talk about that because they know [other coun- tries] have things available that [the U.S.] doesn't have." Erik L. Mertens, M.D., F.E.B.O., medical director and eye surgeon, Medipolis, Antwerp, Belgium, uses two such lenses frequently—the FineVision IOL (PhysIOL, Liége, Belgium), a diffrac- tive trifocal lens, and the bifocal Lentis MPlus (Oculentis, Berlin; Topcon Europe, Rotterdam, the Netherlands). "The distance vision is very good," he said. "The visual quality is very good, much better than other premium lenses or other multifocal lenses." Dr. Mertens said that having more choices means that European surgeons are currently at an advan- tage over their American colleagues. "IOLs are a well-established technology in cataract surgery and refractive lens ex- change," Dr. Mertens said. "When sur- geons have more ability, more models, they can better select the IOL model that is the best choice for a patient, taking into account the patient's daily activities, and so on." Carl Zeiss Meditec (Jena, Germany) has the Acri.Tec line, which is a small-incision toric multifocal. Rayner (East Sussex, England) has a hy- drophilic acrylic toric multifocal and toric multifocal as- pheric Sulcoflex lenses, which are ad- ditive lenses, for pig- gybacking in pseudophakic pa- tients, according to Mark Packer, M.D., clinical associate pro- fessor of ophthalmol- ogy, Casey Eye Institute, Oregon Health & Science University, Portland. "There's a lot of technology available in Europe, and many of these companies have no plans to bring these to the U.S. because of the hurdles of FDA approval and the ex- pense that entails," Dr. Packer said. "I think they'd love to do it if it was a little easier and if success was more assured, but unfortunately, in today's climate, that's just not possible." What Europeans are using Dr. Mertens said his American col- leagues often ask him about the Lentis MPlus. "The multifocal concept is well established in the States with the ReSTOR (Alcon, Fort Worth, Texas), but they don't know anything in the States about the bifocal concept and they are wondering what kind of re- sults we're getting," Dr. Mertens said. According to a story published last year in EyeWorld, with the MPlus, an "aspheric, asymmetric far- vision zone is combined with a sec- tor-shaped near-vision zone of +3 D allowing for seamless transition be- tween the far and near vision zones." Dr. Packer said the MPlus offers a "wow factor" that interests him. "As someone who is interested in optics, I look at that design in February 2011 December 2011 What's ahead in 2012 by Jena Passut EyeWorld Staff Writer Europe's advantage: Surgeons enjoy more premium IOL options, but still look to the U.S. for innovative ideas Addressing costs How the laser will be paid for is still being explored. According to Dr. Grabner, in premium lens cases, costs will probably be assigned to the patient. "In Germany, there are centers that make the patient pay $1,000 more," he said. Dr. Nuijts said the costs of the procedure cannot be addressed from one standpoint and will depend on the healthcare system where the practice is located. In the Netherlands or in West- ern Europe, it is difficult at present to incorporate this technology into regular cataract surgery because in- surance companies and regulatory affairs want to know what the bene- fits of the new technology are in terms of efficacy and safety in com- parison to the existent methods. Dr. Grabner believes prices will drop and the click fee will be in the range of $117 to $200 per case, while the machines may come down to about $315,000, and servic- ing will come down to about $25,000. The future of the femtosecond laser Currently, there are some limita- tions to the laser including the density of nucleus that can be frag- mented, Dr. Nuijts said. There is also the question of how far away sur- geons have to stay from the poste- rior capsule. "I think in time we will have better visualization and better OCT technology, which will give us more reliability on how far we are from the posterior capsule," he said. "Ultimately, I think femto phaco will make it into the market, but it will take some time because this is a totally different strategy that cataract surgeons will have to follow in the next couple of years," he said. EW Editors' note: Drs. Dick, Grabner, and Nuijts have financial interests with Alcon. Contact information Dick: +49 234 299 3101, burkhard.dick@kk-bochum.de Grabner: +011 43 662-4482-3701, g.grabner@salk.at Nuijts: +31-43-3875346, rudy.nuijts@mumc.nl Femtosecond continued from page 30 Erik L. Mertens, M.D., performs cataract surgery on a patient in Belgium. European clinicians have access to more multifocal IOLs than their American counterparts Source: Erik L. Mertens, M.D., F.E.B.O. AT A GLANCE • Europeans have a wider range of choices when it comes to premium lenses • Some practitioners blame the slow FDA approval process • Doctors discuss the latest innovations and eagerly await their approval here continued on page 32

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