Eyeworld

EW MEETING REPORTER 112 Reporting from Hawaiian Eye 2015, Maui, Hawaii January 17–23 after implantation. This is where the Light Adjustable Lens comes in, he said. It is the first lens designed to be adjusted after implantation, which is achieved by treating the lens with UV light. The IOL is a 3-piece silicone IOL with a 6 mm biconvex optic. It has a round anterior edge and a square posterior edge, 13.0 mm blue C loop PMMA haptics, and a posterior layer with higher concentration of UV absorber. In order to treat the refractive error, the lens is exposed to a specific spatial irradiance profile of UV light that polymerizes photosensitive macromers in the periphery of the lens, Dr. Miller said. The unpolym- erized macromers from the center of the lens flow down their concentra- tion gradient to the periphery. The use of the Light Adjustable Lens requires some postoperative eyewear for patients as the treat- ment concludes. The patient would need to wear either clear or dark UV blocking glasses postoperatively both indoors and outdoors until af- ter the last lock-in treatment to help prevent premature polymerization of the photosensitive macromers. Dr. Miller said the lens receives 1 to 2 refractive adjustments, de- pending on the amount of astigma- tism. It is also treated with 1 to 2 lock-in treatments to consume all of the remaining macromers. These light treatments are separated by at least 2 days. Although not currently Food and Drug Administration (FDA) ap- proved, the Light Adjustable Lens is in a phase 3 trial in the U.S., with 17 participating sites in the study. As of January 7, 2015, 533 of 600 subjects have been implanted, Dr. Miller said, and enrollment is anticipated to be completed by the first quarter of 2015. Dr. Miller hopes that this lens will be approved by 2017 in the U.S. Editors' note: Dr. Garg has no related financial interests. Dr. Miller has fi- nancial interests with Calhoun Vision. Dr. Trattler has financial interests with Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, Imprimis (San Diego), and Oculus (Arlington, Wash.). New technology The femtosecond laser was a primary topic in the new technology session. James McCulley, MD, Dallas, gave a talk titled "Femtosecond Laser-As- sisted Cataract Surgery Approaching Prime Time." Cataract surgery is increasingly becoming a refractive surgery proce- dure, he said. There are a number of advantages of using a femtosecond laser in the procedure, Dr. McCulley said, including a precise capsulot- omy, enhanced nuclear fragmen- tation, intraoperative reproducible relaxing incisions, and self-sealing cataract incisions without hydra- tion. Dr. McCulley also mentioned potential disadvantages, which include an increased cost, added time for patient education and in the OR, a learning curve, and technique modification. Laser refractive lens surgery is continuing to advance, he said, in terms of both hardware and soft- ware. A new category is emerging in private pay ophthalmic surgery, and femtosecond laser technology will help drive innovation. Laser refrac- tive cataract surgery offers unique precision for capsulotomy and corneal incisions, smaller incisions and laser-optimized wound architec- ture, and improved IOL performance via effective lens positioning (ELP), among other advantages, he said. Editors' note: Dr. McCulley has financial interests with Alcon, Allergan, and Bausch + Lomb. Sealant vs. sutures Terry Kim, MD, Durham, N.C., discussed wound sealants in his presentation, including ReSure Sealant (Ocular Therapeutix, Bed- ford, Mass.). "It's been about a year since the first FDA product has been available," he said. Dr. Kim described how the sealant works. It binds to de-epithelialized tissue via "lock and key." Then, lid movement sloughs the hydrogel off as the epithelium regenerates, and hydrolysis occurs in approximately 7 days, Dr. Kim said. He compared the sealant to sutures. Sutures involve unwanted tissue manipulation, he said. They may also induce adverse events, present the possibility of infection, and necessitate removal. Mean- while, for sealant, there is no tissue manipulation because of the "paint on" application. There are also fewer adverse events, and it sloughs off in tears within 1 week, he said. Editors' note: Dr. Kim has financial interests with Ocular Therapeutix. Cataract surgery complications In the first session on Tuesday, January 20, David Chang, MD, Los Altos, Calif., presented a number of video cases. Dr. Chang's first case involved an unhappy multifocal February 2015 View it now: Hawaiian Eye 2015 ... EWrePlay.org Richard Lindstrom, MD, describes a novel intraoperative keratoscopy to aid in measuring intraoperative axes to treat astigmatism during cataract surgery.

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