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Refractive Survey: LASIK Remains Dominant
Most Surgeons are now Performing Custom Ablations.
Results of the eighth annual "Trends in Refractive Surgery" survey show that LASIK remains by far the dominant refractive procedure for vision correction between -8 D and +3 D. Additionally, three of four refractive surgeons are now performing custom ablations, and three of 10 surgeons are performing custom procedures on almost all of their patients.
The survey, sponsored by the American Society of Cataract and Refractive Surgery and conducted by Richard J. Duffey, M.D., of Mobile, Ala., and David Leaming, M.D., of Palm Springs, Calif., also found increasing interest in phakic IOLs for high myopes, refractive lens exchange for high hyperopes and accommodative IOLs as a preferred option for presbyopes.
The survey, which was mailed to all U.S. members of ASCRS last September, includes the responses of 773 eye surgeons.
Following are other survey results:
- ninety-eight percent of surgeons regularly perform bilateral LASIK in one visit
- more than two-thirds of all lasers in use in the United States are VISX lasers
- about 9% of refractive practices are now using IntraLase technology to cut flaps, with IntraLase increasing its market share
- about 75% of surgeons prefer a flap thickness in a range between 120 mm and 160 mm
- surgeons are charging an average of $300 more per eye for custom ablation
- fourth-generation fluoroquinolones have quickly come to dominate as the postoperative antibiotics of choice, with Zymar and Vigamox together accounting for 88% of this market.
- about 35% of surgeons will perform LASIK on a one-eyed patient
- monovision LASIK remains the preferred surgery for presbyopic patients.
Dr. Duffey notes that no questions on epi-LASIK were included in the survey because the surge in interest in epi-LASIK did not begin until late 2004. He says that future surveys will include questions on epi-LASIK.
ASCRS Hall of Fame Adds Three
Drs. François, Peyman and Sinskey are Honored.
The American Society of Cataract and Refractive Surgery (ASCRS) announced that three more ophthalmology pioneers have been voted into the ASCRS Hall of Fame. The three, Jules François, M.D., Gholam A Peyman, M.D. and Robert Sinskey, M.D. were nominated and elected by their peers in ASCRS.
Following are brief biographies of each new honoree:
Jules François, M.D., Ph.D., Belgium (1907-1984)
Dr. Jules François studied medicine at the University of Louvain, and graduated in 1930. He began a private ophthalmologic practice in Charleroi, while also conducting scientific work. Dr. François is also served as director of the ophthalmology clinic of the University of Ghent and emeritus professor of the faculty of medicine.
Among Dr. François' major accomplishments was detailing the anatomy of the central retinal artery of the optic nerve. With Guy Veriest, he designed instruments for tonometry, perimetry, dark adaptation and electro-oculography. He described a number of syndromes including vascular pseudopapillitis, corneal dystrophies, facial dysostosis and dystrophic skin-bone cornea. Dr. François published more than 1,500 scientific papers during his career and wrote or edited 30 books and numerous book chapters.
Gholam A. Peyman, M.D., USA (B. 1937)
Dr. Gholam Peyman is a professor of ophthalmology and co-director of the vitreoretinal service at Tulane University. He is a pioneer in vitreoretinal surgery and intraocular drug delivery. In 1971, Dr. Peyman began evaluating the injection of antibiotics into the vitreous for the treatment of endophthalmitis.
Dr. Peyman was one of the first to implant an artificial silicone retina beneath the retina in three patients with retinitis pigmentosa. He was the first to transplant retinal pigment epithelial cells in the treatment of age-related macular degeneration and is a pioneer in evaluating photodynamic therapy. He was one of the developers of the first intraocular telescope for patients with macular diseases. Dr. Peyman also developed a method of modifying refractive error with an excimer laser used beneath a corneal flap (LASIK), for which he received a patent in 1989.
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Robert M. Sinskey, M.D. |
Robert M. Sinskey, M.D., USA (B. 1924)
Dr. Robert Sinskey received his medical degree and performed his ophthalmology residency at Duke University School of Medicine. From 1951 to 1953, Dr. Sinskey was assigned to the Atomic Bomb Casualty Commission in Hiroshima and Nagasaki, Japan. In 1955, he became the first full-time instructor and opened the eye service at the University of California at Los Angeles (UCLA).
Dr. Sinskey patented his internationally popular modified J-loop IOL, and invented several surgical instruments. He pioneered the use of low-power IOLs and the use of IOLs in infants and children with cataracts. Dr. Sinskey is currently medical director emeritus of the Southern California Lion's Eye Institute, clinical professor of ophthalmology at the Jules Stein Eye Institute at UCLA, and on the staff at St. John's Health Center in Santa Monica, Calif. From 1999 to 2000, Dr. Sinskey served as president of ASCRS. He has been the driving force behind constructing and equipping the foundation's Robert M. Sinskey Pediatric Eye Care Clinic in Addis Ababa, Ethiopia.
IN THE NEWS
New glaucoma treatment. SOLX, headquartered in Boston, has begun a U.S. clinical trial for its DeepLight 790 Laser therapy for glaucoma. The primary goal of the study, which will encompass 180 eyes at up to 10 sites, is to assess the treatment's effectiveness in lowering IOP compared to trabeculectomy.
The DeepLight 790 has already earned the CE Mark in Europe.
IntraLase Used in Keratoconus Treatment
The Laser Creates Precision Channels for Intacs Insertion.
Intacs intracorneal ring segments were recently approved for treating recurrent keratoconus with or without a corneal transplant.
The advent of the IntraLase femtosecond laser and its ability to create precision channels in architecturally abnormal and thinned keratoconus corneas allows safe insertion of Intacs into a keratoconus graft, according to Ming Wang, M.D., Ph.D., clinical associate professor of Ophthalmology at the University of Tennessee and Director of Wang Vision Institute in Nashville, Tenn.
IntraLase technology is more commonly used to create corneal flaps in LASIK surgery.
Dr. Wang presented his research on the use of Intacs inserts, assisted by femtosecond laser, to treat corneal ectasia on corneal transplant patients at the recent annual meeting of the American Society of Cataract and Refractive Surgery. He said the use of Intacs intracorneal ring segments represents the first treatment designed to address the root cause of the keratoconus disease process, namely corneal wall weakness. It works by providing the tissue increased structural integrity as well as a tenting effect to help restore the corneal shape in keratoconus eyes, he said.
"Traditionally, when a disease recurs on a transplant, a repeat graft is the only treatment. However, it carries a much higher risk of graft rejection," Dr. Wang said.
The first person to undergo this new procedure was a 27-year-old keratoconus patient, who had corneal transplants in the past but experienced recurrence of the disease on the graft and progressive loss of vision to the legally blind level. The patient complained of severe monocular diplopia and contact lens intolerance. He was devastated since he could no longer function properly at his job.
"The fact that keratoconus can recur on a graft suggests that perhaps the cause of this disease is influenced by both intrinsic (collagen tissue weakness) and extrinsic factors (ocular surface biochemical environment)," Dr. Wang explained.
"In general, when a disease recurs on a transplant, we have no good treatment for these patients. Do we do another graft? If we do, we risk a much higher chance of rejection; if we don't, the patient will remain blind. But now, the femtosecond laser-assisted Intacs ring treatment changes all that," Dr. Wang said.
Three months after surgery, Dr. Wang's initial patient showed significant improvement of his condition with elimination of the keratoconus cone and a regularized cornea. "The patient is thrilled with his vision since now he can even wear glasses and see 20/20 with no diplopia," reported Dr. Wang, who since January 2005 has performed 25 surgeries with good results.
"I believe that Intacs assisted by femtosecond laser represents a promising new treatment that might stabilize these keratoconus corneas and slow down or even halt disease progress and thus avoid corneal transplantation or repeat grafts. It will change the way we think about the treatment for this disease and revolutionize the care for our keratoconus patients," said Dr. Wang.
IN THE NEWS
AMO acquires IOL company.
Advanced Medical Optics, Inc. (AMO) said it has exercised its option to acquire Quest Vision Technologies, Inc. Financial terms were not disclosed.
We have spent the past year working together with Quest Vision and a number of scientific and clinical advisors on accommodating IOL concepts," said AMO president and CEO Jim Mazzo. "Our research has been very productive and we are enthusiastic about the potential of Quest Vision's proprietary technology which is distinct from others under development in the industry because it uses the concept of a shape-changing optic to provide accommodation, rather than an axial movement used in single- or dual-optic alternatives."
Soothe available online. Alimera Sciences Inc., an ophthalmic pharmaceutical company, said its Soothe Emollient Eye Drops are now available for purchase over the Internet. To order the over-the-counter eye drops, consumers and professionals can visit www.sootheeyedrops.com or link from Alimera Sciences' home page.
In addition, the site will continue allowing consumers to search for local retailers, and the company has added to the search option national chain pharmacies selling Soothe.