Eyeworld

Reporting from OIS@ASCRS, May 5, 2016 New Orleans EW MEETING REPORTER 80 May 2016 Other panelists commenting on the state of the MIGS environment included Robert Cionni, MD, Salt Lake City, and Richard Lewis, MD, Sacramento, California. Dr. Lewis said that while glaucoma specialists might be slower to adopt new tech- nologies and techniques, "they've come around" when it comes to MIGS. This MIGS spotlight was fol- lowed by the insightful—and often lively—"Masters of the Universe" panel discussion among some of the top leadership in the ophthalmic industry. It was moderated by Jim Mazzo, executive chairman and CEO, AcuFocus. These leaders in- cluded Mike Ball, CEO, Alcon; Tom Frinzi, president, Abbott Medical Optics and senior vice president, Abbott Laboratories; William Link, PhD, managing director, Versant Ventures (San Francisco); Ashley McEvoy, company group chairman, Johnson & Johnson Vision Care (Jacksonville, Florida); William Meury, executive vice president for branded pharma, Allergan; Ludwin Monz, PhD, president and CEO, Carl Zeiss Meditec; and Calvin Roberts, MD, senior vice president and chief medical office, Bausch + Lomb. Discussion ranged from what to expect from devices in an apparently pharma-focused market to topics like acquisition, leadership changes, consolidation, and more. Mr. Meury offered some obser- vations as someone relatively new to the ophthalmic industry. "I've worked across psychiatry, gastroenterology, infectious disease, neurology, allergy and … I've never seen a relationship exist among companies, whether it be on the pharmaceutical or device side, in- vestors, and the actual practitioners, the specialists themselves," he said. "There's nothing like it in the indus- try. I think it is incredibly refreshing. I think it's incredibly productive. … There is a middle ground, and the eyecare space has perfected the mod- el, and I think it does great things for innovation." EW Editors' note: The speakers have financial interests with the companies represented at OIS. will play an important role in early glaucoma, and MIGS occupies a very important role in that early phase, in that middle, mild to moderate disease patient, whether it's com- bined with phaco or not. Certainly the future looks bright," he said. The first company presentation came from Chris Calcaterra, chief commercial officer, Glaukos (Laguna Hills, California), who spoke about taking a MIGS company public. Glaukos made its debut on the New York Stock Exchange in June 2015, but the company started preparing for its IPO a year earlier. At the end of day 1, Glaukos sold 6.9 million shares at $18 a share. Next up, David LeCause, vice president of U.S. eye care, Allergan (Dublin), spoke about acquiring the MIGS company AqueSys (Aliso Viejo, California), which makes the XEN Gel Stent. Acquiring a compa- ny can take a "varying amount of time," Mr. LeCause said, but what's important in the process is to "get to know the company" and to "think big," as in "paradigm changing tech- nologies." Also highly important in the growing MIGS world is navigating the FDA regulatory process. Sean Ianchulev, MD, chief medical offi- cer, Transcend Medical (Menlo Park, California), was on hand to speak about this, saying that some changes and guidelines have actually made it more predictable to wade through. Still, it's not quick. Transcend's own process with the FDA to conduct a clinical trial to compare the effect of its CyPass Micro-Stent with cataract surgery to cataract surgery alone took 16 versions of the study proto- col, 7,000 pages of correspondence and submissions, and 7 years. Other presentations included Dave Van Meter, CEO and president, Ivantis (Irvine, California), speaking about the Hydrus Microstent, and Russ Trenary, president and CEO, InnFocus (Miami), speaking about the InnFocus Microshunt. Both of these devices have potential as standalone procedures. Panelist Jai Parekh, MD, Woodland Park, New Jersey, said he thinks decoupling some MIGS from cataract surgery is a positive direction, making earlier intervention possible. stressed the importance of team- work. When asked for his advice to young ophthalmologists who want to be "the next Roger Steinert," Dr. Steinert said what people need to do is to pick up little pieces here and there and incorporate them into their own personality; that's where you'll be a true innovator in your own way, he said. A new session, WTF@OIS (What's the Future), was moderat- ed by Gilbert Kliman, MD, Menlo Park, California, and Stephen Slade, MD, Houston, and featured compa- nies that are doing something new in ophthalmology. The companies included Equinox (Sioux Falls, South Dakota), Presbyopia Thera- pies (Coronado, California), Stroma Medical (Laguna Beach, California), Eyenovia (Tampa, Florida), and Wicab (Middleton, Wisconsin). Their new product ideas included goggles to help those with glau- coma and to control pressure in the eye, eye drops for presbyopia, a procedure to change eye color, microdrops using inkjet technology to print drops onto the eye, and non-surgical technology to help blind people form an image of the scene around them. Glaucoma industry bubbling with innovation One of the closing sessions at OIS@ ASCRS included a spotlight on the coming of age for microinvasive glaucoma surgery (MIGS). "I know glaucoma might not be the sexiest thing yet, but just watch and you'll see that it will [be]," said Ike Ahmed, MD, Toronto, modera- tor of the session "MIGS Is Growing Up." While IOP-reducing drops are a mainstay of treatment, Dr. Ahmed noted problems like compliance and side effects. For the more severe glaucoma patient, surgical options include trabeculectomy and tube shunts. But what about the mild to moderate glaucoma patient look- ing to get off some, if not all, of their medications? Calling this stage interventional glaucoma, Dr. Ahmed said it's where MIGS comes into play. "I think what we'll see in the future is a world where drugs Sponsored by

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