ASCRS Symposium & News Notes from the ASCRS Symposium

New president

I. Howard Fine, M.D., of Eugene, Ore., was named president of the American Society of Cataract and Refractive Surgery at this year's symposium.

"Howard Fine is a brilliant surgeon and innovator, a great advocate for our patients and our profession, and a remarkable individual. It gives me tremendous pleasure to turn over the presidency of this organization to him," commented outgoing president Douglas Koch, M.D.

Dr. Fine addressed the issue of declining reimbursement, for cataract surgery in particular. He advised his fellow ophthalmologists to "resist the urge to personalize external messages. We shouldn't allow ourselves to feel like victims of our success."

Best poster awards

• Cataract. Winner: Suresh K. Pandey, M.D.: Interlenticular opacification after piggyback IOL implantation.
  • Honorable mention: Lourdes Fernández, M.D.: Phacoemulsification in previously vitrectomized eyes.
• Refractive. Winner: Melania Cigales, M.D.: Surgical treatment of flap folds after LASIK.
  • Honorable mention: John T. LiVecchi, M.D.: Presbyopia: the final frontier.
• Special interest. Winner: Mark A. Terry, M.D.: Replacing the endothelium without surface corneal incisions or sutures: first U.S. experience with posterior lamellar keratoplasty.
  • Honorable mention: Edna Angel-Muñoz, M.D.: Histopathologic findings in keratitis secondary to silicone oil.

Wavefront today

As part of the VISX Clinical and Technology Presentations, John F. Doane, M.D., of Discover Vision Centers in Kansas City delivered the following remarks:

"Wavefront analysis has three basic applications in clinical practice: correction of previously complicated cases, correction of unoperated abnormal corneal/ocular wavefronts and, lastly, as a diagnostic tool for the preceding and other ocular conditions, such as dry eye.

"FDA approval of wavefront-guided corrections may be several months to several years from achieving routine clinical practice status. But does this mean a practice should wait to get involved? Absolutely not.

"I can recall my first talk on topography systems in 1993 in which one of my last slides discussed the "futuristic" application of topography to guide laser ablations. In 1995-1997, I witnessed topography-linked ablations. For various reasons, this approach wasn't the end-all to customized treatment. Nevertheless, today, no one is waiting to buy a topography unit until topo-linked ablations come into reality. We can make the same argument when it comes to wavefront analyzers.

"We have significant evidence that they provide us with diagnostic abilities that would augment the typical clinical practice. For example, because 66% of the refraction occurs at the air-tear film interface, Shack-Hartmann-style analyzers are superb tools to objectively quantitate root mean square spot-size values and to provide objective data to patients about the optical performance of their tear film.

"So, we should enter the wavefront era. How? By performing due diligence and educating ourselves on available systems. When? As soon as we're comfortable with the purchase. Why? For all the above reasons."

Virtual optical

Dispense high-quality eyewear in a way that's simple, inexpensive and fun for the patient? Generate an ongoing revenue stream with a fraction of the investment and resources required by the typical optical shop? Voyant Corporation says its try-on technology can make it happen.

Co-developed by Charles Kelman, M.D., especially for ophthalmology practices, the Voyant system includes a computer workstation placed in your office. At the beginning of the visit, an assistant takes the patient's digital photograph and measures his pupillary distance. At the end of the visit, the patient goes to a second workstation, where the system recommends a selection of frames from the inventory based on his physiognomy. The patient "tries on" the frames using his digital image. He makes his choice; the assistant enters the pertinent prescription data into the fitting program; and the order is sent electronically to the assembly facility, where an optician oversees the fitting of the lenses. The glasses are then shipped via Airborne Express to the practice or the patient.

A streamlined process for sure. But will demanding patients be satisfied with the frame and lens selection? Voyant says its frame styles have been created to reflect the best-selling shapes, silhouettes and materials. More than 100 styles are available today, and more arrive each month. The company's proprietary lenses have been created in partnership with Rodenstock, using its Automated Prescription Technology. Voyant has access to any other lenses recommended by the doctor.

And what happens when patients have problems with their glasses? Voyant says its digital technology can provide a customized eyewear fit the first time, but all eyewear can be returned to Voyant for adjustments, re-do's, exchanges or refunds.

Conserving cornea

During the pre-ASCRS Codet-Aris Vision Institute Refractive Surgery Symposium in Tijuana, Mexico, sponsored by Nidek, Steven Ma, M.D., described his multistage, multizone LASIK treatment using the EC-5000 excimer laser.

By performing two to eight separate, consecutive ablations of varying zone diameters on the operative eye, Dr. Ma has been able to conserve 20 to 30% more corneal tissue than would have been conserved with a conventional single-stage treatment.

He's used this approach, which he calls "Custom-Eyes LASIK Technique," in more than 500 procedures, and has found he can tailor ablation protocol for functionally larger optic zones, high myopia, and any eye where he needs to decrease the risk of ectasia compared to conventional single-stage ablation.

Each stage has a different optic and transition zone, requiring its own nomogram. Also, operative time is longer. But Dr. Ma believes this technique enhances long-term safety of ablative procedures.

R&D initiative

Bausch & Lomb is creating a new company -- Technovision -- to research and develop new refractive surgery technologies. Kristian Hohla, who founded the Technolas laser business in 1985, will serve as president.

In other refractive surgery news, B&L unveiled its enhanced Hansatome Microkeratome. The updated instrument is designed to increase corneal flap consistency, reduce flap compression by reducing sensitivity to the blade extension, and enable smaller-aperature patients to undergo LASIK.

Medication update and more

Alcon is receiving positive reports from doctors prescribing Travatan (travoprost), which the FDA approved on March 16. The company says IOP reduction has been as good as or better than in clinical trials for patients who were previously being treated with other drops or combinations of drops. Doctors are also seeing the increased efficacy in African American patients that was exhibited in the trials.

A few mild cases of hyperemia have been reported, but have resolved in 1 to 2 weeks. Wide distribution of Travatan to pharmacies has been achieved.

Alcon Summit Autonomous introduced its LADARVision upgrade, the LADARVision 4000. Ergonomic enhancements improve surgical control and patient comfort. Also introduced was the LADARWave CustomCornea Wavefront System.

Enhanced acrylic IOL

Allergan announced that its Sensar Acrylic IOL will soon be available with OptiEdge Design. A rounded anterior edge scatters light, which can reduce internal reflections; a sloping side edge reduces the surface area than can cause internal reflections; and a squared posterior edge facilitates 360° contact with the posterior capsule.

Steven H. Dewey, M.D., said OptiEdge gives him "happier patients faster. I've been able to spend less chair time with these patients because they're not experiencing post-op dysphotopsia."

Allergan also said it has had no reports of vision-dulling vacuoles with the Sensar.

And . . .

• The Outpatient Ophthalmic Surgery Society has endorsed Suppleye.com's Web-based business-to-business purchasing and inventory management system for ASCs, which includes barcode scanning to automate IOL reordering, reporting and tracking.
• In May, LaserSight Inc. began delivering its UltraShaper durable keratome. The company said the instrument's simplicity and safety profile will appeal to all refractive surgeons, but especially those who developed their technique using the Automated Corneal Shaper. The company also said it plans to license its refractive surgery patents (22 U.S. patents currently issued or allowed, and more than 25 pending) to other manufacturers.
• Pharmacia Corp. reported that its recently FDA-approved CeeOn Edge 911A square-edged, silicone, foldable IOL exhibits optical clarity and a low incidence of posterior capsule opacification. Also, Pharmacia has received few reports of glare, glistenings or other undesirable visual effects.

New facility

Novartis Ophthalmics is relocating its North American headquarters to a new facility, above, in Johns Creek (northeast of Atlanta) this summer. Novartis Ophthalmics has completed its transition from CIBA Vision and become a separate eye-health unit operating under the Pharmaceutical Division of parent company, Novartis AG.