Eyeworld

79 June 2017 EW MEETING REPORTER modalities, the opportunity that nanotechnology presents in the realm of drug delivery, how devices are playing a role in dry eye, and more. Shifting gears, a panel assem- bled to discuss opportunities for correction of low myopia that could play a role in "making myopia great again." The myopic population, said Michael Lachman, president, of EyeQ, San Francisco, is heavily weighted toward the low end of the myopic spectrum, which he defined as between –0.5 D to –2 D. Forty- seven million American adults fall into the low myopia category. From a refractive surgery standpoint, only 10–15% of patients are being treated surgically for low myopia, Mr. Lachman said. Stephen Slade, MD, Houston, facilitated a discussion of the various refractive correction options—PRK, LASIK, PiXL (photorefractive intras- tromal crosslinking, Avedro), SMILE (small incision lenticule extraction, Carl Zeiss Meditec, Jena, Germany), and contact lenses—among the pan- el, which included Laurent Attias, senior vice president of Alcon, Fort Worth, Texas; Terence Koritz, vice president of global strategic market- ing, surgical, Johnson & Johnson Vision, Santa Ana, California; Rajesh Rajpal, MD, CMO of Avedro; Steve Schallhorn, MD, CMO of Carl Zeiss Meditec; and Calvin Roberts, MD, senior vice president and CMO of Bausch + Lomb, Bridgewater, New Jersey. The pros and cons of the various options were debated. In the end, the audience voted via a polling app that they thought LASIK and PiXL presented the best opportunity to make refractive surgery more attrac- tive to patients with low myopia. EW Editors' note: The speakers at OIS have financial interests with the companies they represent. During this time on the dry eye front, Sun Pharma has completed some clinical studies of OTX-101, which Mr. St. Peter described as a novel aqueous nanomicellar formu- lation of cyclosporine A in a clear, isotonic ophthalmic solution with a neutral pH. Seph Jensen, CEO of TearLab, San Diego, announced the compa- ny's new generation diagnostic plat- form—TearLab Discovery—which he said is first going to focus on testing for inflammatory dry eye. The first test card will include osmolarity, MMP-9, and IL-1Ra, the latter two being inflammation markers highly associated with dry eye disease. Oth- er ocular markers, as well as systemic markers, are future possibilities for this technology as well. This device has already achieved the CE mark for one of its markers, and TearLab plans to launch at the 2018 ASCRS• ASOA Symposium & Congress, Mr. Jensen said. Finally, Joe Boorady, OD, CEO of TearScience, Morrisville, North Carolina, highlighted LipiFlow, which since its 2011 approval has treated more than 175,000 people with meibomian gland blockage leading to dry eyes. Dr. Boorady said meibum expression can be done manually, but it takes chair time and can be painful to the patient. LipiFlow, on the other hand, uses heat to melt the meibum and combines pulses for expression that is not painful to the patient. Dr. Boorady introduced TearScience's Activator II for the LipiFlow, which is meant to reduce medical waste and make the device faster to use. A panel of ophthalmologists— Alice Epitropoulos, MD, Columbus, Ohio, Sumit "Sam" Garg, MD, Irvine, California, Terry Kim, MD, Durham, North Carolina, and Stephen Lane, MD, Stillwater, Minnesota—discussed innovation in dry eye, expressing particular interest in the various diagnostic increase as the size of the older pop- ulation living longer also increases. In addition, physicians are seeing younger patients with lifestyle-re- lated dry eye, such as contact lens wear, refractive surgery, and screen time. All the while, the number of ophthalmologists is expected to decrease. On the other hand, there has been significant innovation in diag- nosis and treatment of dry eye, Dr. Holland said, naming the products of several companies that have been brought to the market to better serve in diagnostics and treatment. "A lot of things have happened in the last decade that have certainly made us better clinicians, and we know this market is going to explode," Dr. Holland said. Aziz Mottiwala, vice president of marketing, Allergan, stepped up to discuss TrueTear. This is the first neurostimulation device in the eyecare field; it's drug-free and provides patients the opportunity to produce tears on demand. Target- ing the trigeminal nerve, TrueTear uses an electrical pulse to produce a physiologic response that results in complete tear production with aqueous, mucin, and proteins. Amir Shojael, PhD, vice pres- ident of global development and product strategy lead, Shire, Lexing- ton, Massachusetts, discussed Xiidra (lifitegrast), which he said is the first and only approved product in the U.S. to treat signs and symptoms of dry eye disease and is a new class LFA-1 antagonist. As for what's new, Dr. Shojael said Shire recently an- nounced a licensing agreement with Parion Sciences (Durham, North Carolina) for its epithelial sodium channel inhibitor compound that's currently in Phase 2 trials. Sun Pharmaceutical Industries (Mumbai, India) has only been in the ophthalmic sphere for 2 years, said Jerry St. Peter, vice president and head of ophthalmic business. (Palo Alto, California), Avedro (Waltham, Massachusetts), ClarVista Medical (Aliso Viejo, California), Omega Ophthalmics (Lexington, Kentucky), Mynosys Cellular Devices (Fremont, California), PowerVision (Belmont, California), Refocus Group (Dallas), AcuFocus (Irvine, California), ReVision Optics (Lake Forest, California), Presbia (Dublin, Ireland), Presbyopia Therapies (Coronado, California), and SightLife Surgical (Seattle). The OIS Innovator Award was presented during the meeting's networking lunch to Oculeve (now part of Allergan, Dublin, Ireland), with Michael Ackermann, PhD, San Francisco, accepting the award. By teaming up with Allergan, Oculeve delivered the breakthrough TrueTear, said William Link, PhD, San Francisco, one of the meeting's chairmen, while introducing Dr. Ackermann. This intranasal neu- rostimulating device increases the production of natural tears and was recently FDA approved. Other in- dustry leaders and physicians spoke in a video tribute about the value of TrueTear as a tool to produce tears on demand, which can be particu- larly helpful for those patients with dry eye. Dr. Ackermann thanked the many people over the years who have worked on the device with him when he accepted the award. Editors' note: The speakers at OIS have financial interests with the companies they represent. Spotlight on dry eye During the second half of the OIS meeting, the spotlight turned onto dry eye. Edward Holland, MD, Cincin- nati, led the session by providing statistics about the prevalence of dry eye—344 million diagnosed world- wide and 20–30 million in the U.S. He said, however, the number of people with dry eye is only going to

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