EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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June 2012 EW MEETING REPORTER 65 more repeatable and more perfect in centration, can we improve out- comes?" he said. "The opening of the capsule should, we think, affect the final resting position of the lens. The manual capsulotomies that we do vary in centration and circularity. As that capsule contracts it shrink- wraps around the implant and can push it around. The laser capsulo- tomy may give us a more constant effective lens position." The other problem, he said, is an irregular/decentered capsulotomy will contract asymmetrically, induc- ing coma and astigmatism, as well as other aberrations. Dr. Steinert went over the potential positives and neg- atives of femto. The potential posi- tives, which he called "significant," are better primary incisions, astigmatism control through size and orientation, less risk of endoph- thalmitis, and better astigmatic inci- sions that are more reproducible than anything with a human hand. "These purely intrastromal inci- sions have everyone intrigued be- cause they don't violate the surface, there's no risk for infection," he said. "They should be more con- trolled but won't be as powerful; but a lot of the use of this will be for lower level astigmatism, which is re- ally where most of the astigmatism is." Dr. Steinert listed the use of less ultrasound energy (which is better for the endothelium) and less nucleus manipulation as other po- tential benefits to using the fem- tosecond laser for cataract surgery. "We have here technology that may be the first major change that makes the procedure easier," he said. "The most positive impact of this technology may be for the average surgeon." The most glaring negative, Dr. Steinert said, is money. "My personal feeling is better technology has historically trumped cost. We find a way to make it work," he said. There's also the time factor, as using the laser increases total time per patient. The specific surgical challenges include patients with small pupils. "There will be cases where we can't do the capsulotomy [with the laser], so there's a need to maintain manual skills," he said. "My per- sonal conclusion is we certainly know laser refractive cataract surgery will resonate with patients, similar to the all-laser LASIK. Outcomes should improve, but we have to prove that." There are a lot of variables to the systems, Dr. Steinert said, includ- ing graphic user interface, imaging technology, patient interface, avail- able incision patterns, and how the nucleus is pre-treated. The current systems on the market are LenSx (Alcon, Fort Worth, Texas), IntraLase (AMO), Victus (B+L/Technolas, Munich), LensAR (Orlando), and Catalys (OptiMedica, Santa Clara, Calif.). The big picture: Innovation in ophthalmology Dr. Lindstrom was next at the podium to give a broad overview of the clinician's perspective on the emerging technologies OIS@ASCRS attendees heard about over the course of the day. "In spite of all the rhetoric, healthcare spending keeps growing," he said. "We have an aging popula- tion and a rising disease burden. Despite the fact that some people believe innovation is going to raise costs, innovation has the best chance at reducing costs. The only reason we can take care of our pa- tients is because of the impact of in- novation." Many of these companies are finding that they can outsource in- novation more inexpensively than they can do it themselves. Research spending has been growing, he said. "We're seeing a transition, espe- cially in ophthalmology, to cash pay," Dr. Lindstrom said. "It's not all third-party pay anymore," which is driving a focus toward customer service. The industry is also seeing a col- laborative increase between ophthal- mologists and opticians, he said. The provider network, which Dr. Lindstrom called the "distribution channel of new technology," is strong in the U.S. There are 19,000 ophthalmologists and 38,000 optometrists. "We are all doing well, which means we can acquire new technol- ogy as it evolves," he said. Dr. Lindstrom called the aging population "critical to ophthalmol- ogy innovation" because a patient over 65 years of age consumes 10 times the amount of eyecare that a patient under 65 does. Key relevant eye diseases for this population include cataract, glaucoma, ocular surface disease, dry eye, allergy, and age-related macular degeneration. Finally, James V. Mazzo, presi- dent of AMO, wrapped up the ses- sion with a talk on the lessons he learned as president of AdvaMed, the world's largest medical device as- sociation. AdvaMed "advocates for a legal, regulatory, and economic en- vironment that advances global healthcare by assuring worldwide patient access to the benefits of medical technology" (www.advamed.org). Annual death rates have de- clined 16% since 1980, and life ex- pectancy has risen by more than 3 years. Disability rates have dropped by 25%, and a study from the Uni- versity of Chicago found that im- provements in life expectancy from advancements in cardiovascular care alone added 2.6 trillion per year to U.S. wealth between 1970 and 1998. "We bring devices [to market] that add income, that add jobs," he said. "That's the message we have to give to our legislators. It's not that we're adding costs, we're adding re- sults." Mr. Mazzo urged attendees to make sure submissions to the FDA are "of the highest quality" and pointed out that it's an active time for Medicare. "The formation of ACOs [ac- countable care organizations] is the foundation of the healthcare deliv- ery system," he said. "If you don't know about an ACO, I suggest you pay strict attention to how it's going to interact because this is something that carries a lot of momentum as we go forward." The next OIS meeting will be held right before the American Academy of Ophthalmology annual meeting in November. It will be a full-day meeting focused on drugs, drug development, and diagnostics. Visit ophthalmologysummit.com for more information about the agenda as the meeting draws closer. EW Editors' note: Dr. Ahmed has financial interests with Glaukos and AqueSys. Dr. Cunningham is the founder of OIS. Dr. Donnenfeld has financial interests with Glaukos. Dr. Holladay has finan- cial interests with Alcon and AMO. Dr. Lindstrom has financial interests with Glaukos, AqueSys, and Transcend Medical. Mr. Mazzo has financial interests with AMO. Dr. Steinert has financial interests with AMO and OptiMedica. Drs. Thompson and Link have no financial interests related to their comments. Contact information Ahmed: Daisy Huerto, on behalf of Dr. Ahmed, daisy.cvec@gmail.com Cunningham: ECunningham@clarusventures.com Donnenfeld: eddoph@aol.com Holladay: holladay@docholladay.com Koch: douglaskoch@mac.com Lindstrom: Brenda L. Boff, on behalf of Dr. Lindstrom, blboff@mneye.com Link: bill@versantventures.com Mazzo: Jim.Mazzo@amo.abbott.com Steinert: roger@drsteinert.com Thompson: vance.thompson@sanfordhealth.org