Eye M.D.s Score High as Innovators

Many have developed useful new devices.

BY JERRY HELZNER, SENIOR EDITOR

In terms of coming up with important new ideas to advance the practice of ophthalmology, today's eye M.D.s are following in the footsteps of such legendary pioneering physicians as Sir Harold Ridley and Charles Kelman.

Dr. Ridley invented the IOL after serving as a flight surgeon in Great Britain's Royal Air Force in World War II. He noticed that when fighter pilots had their canopies damaged in combat, their eyes could tolerate small plastic shards that came off the bullet-riddled canopies. Dr. Kelman invented modern phacoemulsification after having his teeth cleaned with an ultrasonic probe. He immediately saw the connection to cataract removal and eventually convinced the ophthalmology community of the value of his invention.

Today's ophthalmologists may not have come up with anything as transforming as the IOL or phacoemulsification, but their contributions have been — and continue to be — highly noteworthy. For example, I. Howard Fine, M.D., of Eugene, Ore., has spurred numerous innovations in incision technology, Louis "Skip" Nichamin, M.D., of Brookville, Pa., has been a pioneer in IOL insertion devices, and Roger Steinert, M.D. of Irvine, Calif., has created numerous handheld products that are of great value in facilitating refractive procedures.

Widely Adopted Devices

More specifically, George Baerveldt, M.D., of the University of California, Irvine, invented the Baerveldt Aqueous Shunt (Advanced Medical Optics, Santa Ana, Calif.), which has been successfully implanted in thousands of glaucoma patients to lower intraocular pressure (Figure 1). More recently, Bruce Shields, M.D., of Yale University, has developed a novel new glaucoma treatment device called the Aquashunt, which was recently licensed to Opko Health of Miami.

Figure 1. AMO's Baerveldt Aqueous Shunt prior to insertion into the eye.

In cataract surgery, both Iqbal "Ike" Ahmed, M.D., of Toronto, and Cincinnati's Robert Cionni, M.D., have invented highly useful devices that permit the safe removal of cataracts in patients with broken or weak zonules. Dr. Ahmed's device (Figure 2) is called The Capsular Tension Segment (Morcher, Stuttgart, Germany) and Dr. Cionni's is The Modified CTR (Morcher).

Figure 2. The Ahmed Capsular Tension Segment from Morcher.

Steven Dewey, M.D., of Colorado Springs, Colo., has made a major contribution to cataract surgery with his invention of the Dewey Radius Tip (MST, Redmond, Wash.). The Dewey Tip (Figures 3a/b) is beveled with curved edges and significantly reduces the risk of rupturing the capsule when the capsule might inadvertently come in contact with the phaco tip. Though it is not as sharp as some phaco tips, surgeons report that the Dewey tip can cut through the hardest nuclei without much difficulty.

Figure 3a. The Dewey Radius Phaco Tip from MST sprang from an idea to ensure safer cataract surgery.

Figure 3b. The rounded edge of the Dewey Tip is designed to keep the capsule intact despite incidental contact with the tip.

Sina Sabet, M.D., of Alexandria, Va., provided cataract surgeons with a unique and highly useful device with his creation of the Sabet Lenticular Safety Net (Rhein Medical, Tampa, Fla.) for retrieving a dropped nucleus (Figure 4). Though this complication is relatively rare, it is a frustrating event that can create significant problems for surgeons and patients alike. The Sabet device allows the surgeon to retrieve the dropped nucleus with a claw-like arrangement of small wires that is opened once the device is inside of the eye.

Figure 4: The radially expanding wires of Rhein's Sabet Lenticular Safety Net provide a broad surface area for maintaining lens fragments.

One other much-used invention that should be noted was created by a now semi-retired ophthalmologist, Robert Sinskey of Los Angeles. Dr. Sinskey developed Sinskey Hooks (several manufacturers), which have been used for years for intraocular manipulation in a wide variety of ophthalmic procedures.

A Passion for Perfection

John Bee, president of Rhein Medical, Tampa, Fla., probably knows as much about the inventiveness of ophthalmologists than anyone. His company, as well as Katena Eye Instruments (Denville, N.J.), Accutome (Malvern, Pa.), Storz Instruments (Rochester, N.Y.) and others, have brought to market dozens of ophthalmic devices, almost all of which bear the name of the inventor. Many of these devices have been widely adopted into the everyday practice of ophthalmology.

"About 99% of the time, the surgeon comes to us with a concept or drawing and a description of the application. We will then work with the surgeon to create a prototype," says Bee. "Sometimes we explore the concept with other surgeons to determine if they believe such a product could help them."

Bee says that eye surgeons are especially innovative because they are passionate about preserving sight. In addition, they are constantly being confronted by new technologies that in turn create opportunities for individual surgeons to improve procedures.

"The new technologies spur their sense of innovation," says Bee.

Bee is especially excited about one of Rhein's latest product launches, the Roholt Haptic Adjuster, designed by Philip C. Roholt, M.D. of Canton, Ohio.

This instrument is designed to adjust the haptic curvature of a three-piece IOL, changing its overall length for improved centration. Rhein says this innovative instrument is ideal for aspheric optic and multifocal lenses where an asymmetric capsular bag causes mild decentration. The overall length of the lens can be increased or decreased approximately 0.5 mm, depending upon where the haptics are adjusted. In addition, Rhein says the instrument has a unique micro tip that provides easy manipulation within the anterior chamber, with a sliding shaft to reduce IOL movement during the procedure.

How Innovators Think

An insight into the thought processes of innovators is provided by Dr. Dewey, who invented the Dewey Radius Tip after being involved in research into various aspects of cataract removal, IOL design and IOL insertion.

"In looking at phaco needles, I concluded that, with the newer generation of phaco equipment, you didn't need a sharp edge to remove a cataract," notes Dr. Dewey. "You could have a rounded edge and protect the capsule from breaking if there was incidental contact with the phaco tip."

It took 2 years to develop a prototype of the Dewey Radius Tip and another 15 months to launch the product.

"MST introduced the product in early 2006," says Dr. Dewey. "We have been gratified by the response from cataract surgeons who have adopted it. Surgeons tell me that they have had accidental contact between the tip and the capsule, expected the worst, and were relived to see that the capsule was intact."

Dr. Dewey says the effectiveness of his invention is primarily made possible by the advanced technology offered by the newer phaco machines. "Today's phaco machines provide more precise target delivery of energy," he asserts. "Advanced fluidics and power modifications enhance ultrasound capabilities and allow the Dewey Radius Tip to permit safer cataract surgery."

With the Sabet Safety Net, Dr. Sabet studied earlier innovative efforts to retrieve lens fragments and then attempted to improve upon those to develop his invention, whose unique design allows surgeons to stabilize and then retrieve multiple lens fragments.

Innovations in Drugs

It's not only with devices that practicing ophthalmologists have shown innovation. In retina, Philip Rosenfeld, M.D., Ph.D., of Miami successfully pioneered the use of Genentech's cancer drug Avastin to treat wet AMD and in doing so created an effective and low-cost alternative to the more costly AMD drug Lucentis.

Joel Shugar, M.D., of Perry, Fla., who died tragically in a sport parachuting accident in May, created Shugarcaine, an intracameral anesthetic combining lidocaine and BSS Plus (Alcon) that is widely used in cataract surgery. He later invented epi-Shugarcaine (Shugarcaine with epinephrine) for improving dilation during cataract surgery and combating incidents of intraoperative floppy iris syndrome.

One eye surgeon, who asked that he not be quoted by name, says that he has an explanation for the inventiveness of ophthalmologists.

"We work in very small spaces and we are driven to be perfect. Let's face it, we're a little neurotic," he says. "Being so industrious, if we think we can improve a procedure by even a little bit, we try to invent a device that will get us closer to perfect. It's really a good thing that we have these high-achiever, Type A personalities." OM