At the AAO annual meeting in Chicago, on Sept. 30 to Oct. 3, attendees had the opportunity to peruse the exhibition hall to see the latest technologies and innovations available to the ophthalmic industry. In case you missed it, OM contributors offered their top highlights from the 2022 show floor.

DIAGNOSTIC TECHNOLOGY

E-SWIN USA’s tearcheck dry eye analysis provides nine exams for smart, reliable and efficient breakthrough tear-film analysis in less than 10 minutes. The tearcheck allows the user to identify and help diagnose ocular surface disease. In addition, a comprehensive one-page Overview Report is generated that includes all the exam results categorized from normal/mild/moderate/severe. “This report makes it easy to present the patient’s results, compare for change over time with previous exams and educate, based on their degree of severity, the need to treat their chronic progressive disease,” says Cynthia Matossian, MD, FACS.

The E>Eye/IRPL, from E-SWIN USA, also stood out to Dr. Matossian on the show floor. The E>Eye/IRPL is a medical device that has been specifically designed for treating dry eye due to meibomian gland dysfunction (MGD). It generates intense regulated pulsed light by producing calibrated and homogeneously sequenced light pulses. The sculpted pulses are delivered under the shape of a train of pulses. The energy, spectrum and time period are set to stimulate the meibomian glands in order for them to return their normal function.

LKC Technologies’ new RETeval handheld device provides non-invasive and effective full-field ERG and VEP testing. It can rapidly assess diabetic retinopathy, glaucoma and many other optic nerve and retinal diseases. The device features non-invasive LKC-patented sensor strip skin electrodes and color-coded results for easy interpretation — test results are shown on the device or can be exported via a PDF for easy integration into medical records. “RETeval is designed for the anterior segment surgeon to determine macular function in dense cataracts. It performed in about a tenth of the time than an older device we currently have, and it also gave me as much information,” says Mitchell A. Jackson, MD.

The Radius XR platform is a portable vision diagnostic and patient engagement system that combines medical-grade diagnostics, business management and patient education tools in a single wearable augmented reality/virtual reality device. The headset is ideal for in-office testing and education and can be programmed to check visual acuity, conduct visual field testing, and perform other exams (contrast sensitivity, Amsler grid and color scheme) in one wearable device.

“The headset can also play personalized educational videos (eg cataracts, glaucoma or other topic) to give the patient a unique and immersive experience, which also cuts down on doctor and staff counseling time,” says Dagny Zhu, MD.

ZEISS’ VELARA Teleretinal Screening System for retinal screening facilitates early detection and treatment of diabetic eye disease — all within the convenience of a primary care setting. The ZEISS VELARA fundus camera automatically aligns and focuses, enabling staff to capture high-quality images of the patient’s retina. ZEISS VELARA integration software creates and returns the diagnostic report to the patient’s EMR for immediate billing, consultation and treatment.

“Placing VELARA cameras in point-of-care locations can help capture the diabetic patients who are not receiving their recommended eye examinations” says Dr. Matossian. “VELARA leverages a simple image acquisition process that makes the device easy to operate by any individual with minimal training, and it can capture images in a matter of seconds.”

INTRAOCULAR LENSES

AcuFocus Inc.’s IC-8 Apthera IOL is the first non-toric extended-depth-of-focus IOL approved for cataract patients who have as much as 1.5 D of corneal astigmatism. The Apthera IOL, with its proprietary small-aperture technology, provides sharp distance vision as well as clear intermediate and near vision, effectively mitigating the effects of presbyopia. “I believe the Apthera IOL will be ideal for patients with irregular corneas following radial keratometry, penetrating keratoplasty, keratoconus and corneal scars, to name a few indications,” says Eric Donnenfeld, MD.

Lisa Nijm, MD, JD, was impressed by the recently launched Clareon Toric IOL with STABLEFORCE Haptics technology, from Alcon. The latest Clareon Toric IOL completes the Clareon collection for US cataract patients with astigmatism on its latest, glistening-free material. Clareon Toric and Clareon Monofocal consistently deliver a broad refractive landing zone, providing functional intermediate vision while maintaining the expected 20/20 visual acuity at distance.

Dr. Matossian was impressed by the recently launched Johnson & Johnson Vision TECNIS Symfony OptiBlue IOL, a presbyopia-correcting PC-IOL with the new OptiBlue design in the InteliLight portfolio. The InteliLight is a combination of three Johnson & Johnson Vision proprietary technologies: violet-light filter (blocks the shortest wavelengths of light that produce the most light scatter, helping to mitigate halo, glare and starbursts and minimize visual disturbances when driving at night), improved echelette design (helps reduce light scattering and halo intensity, making it easier to see digital devices) and achromatic technology (corrects chromatic aberration for better contrast day and night and provides superior performance across every distance).

Dr. Nijm adds that she particularly likes the TECNIS Symfony OptiBlue IOL’s night vision capabilities.

Another new IOL on the market is the Lenstec ClearView 3 IOL (segmented bifocal lens), which recently received FDA approval. The next-generation asymmetric multifocal refractive IOL is used in adult patients who have cataracts, need eye surgery and only have one diopter or less of abnormal curve to the cornea. The ClearView 3 multifocal IOL is designed to provide patients with near, intermediate and distance vision. Its patented design allows for improved contrast sensitivity and minimized halo and glare. The segmented optic design is the first of its kind in the United States.

“This is a new technology for IOLs, but it’s an old technology when we think about glasses,” says T. Hunter Newsom, MD, of Newsom Eye in Tampa, Fla. “If a patient tolerates a pair of progressives, I tell the patient that this lens is like your progressive glasses — which has a fixed monofocal lens at the top for distance, and a fixed monofocal IOL at the bottom for reading. With the transition, you are used to that loss in your glasses and that abnormality. If you tolerate your progressive glasses, you will tolerate this lens.”

Rayner’s RayOne EMV is a versatile lens that meets the visual needs of a large population of cataract and refractive patients looking for greater spectacle independence. RayOne EMV offers increased range of focus with an emmetropic target and monofocal levels of contrast sensitivity and dysphotopsia due to its non-diffractive design, the company says. Its positive spherical aberration design and the resulting hyperopic tail provides a natural range of vision with a smooth transition between distance and near eyes. “It is the first positive spherical aberration EDOF IOL and provides meaningful intermediate vision while maintaining excellent distance vision,” says Dr. Donnenfeld.

RxSight’s Light Adjustable Lens (LAL) is the first IOL that can be adjusted after cataract surgery. Patients can test drive their vision, allowing for custom, LASIK-like refractive precision and accuracy. The LAL can be adjusted non-invasively through a series of ultraviolet light-based treatments. Errors of up to 2 D of myopic, hyperopic and astigmatic correction can be adjusted, and astigmatism can be corrected down to 0.5 D of cylinder, the lowest level approved to be treated. “I recently had a LAL implanted into my own eyes; my vision is outstanding, and I can see up close and far away,” says Daniel S. Durrie, MD.

There was a lot of interest and discussion in STAAR Surgical’s EVO/EVO+ Visian Implantable Collamer Lens (ICL) for the correction of myopia and myopia with astigmatism, says Dr. Durrie. It provides sharp vision, does not induce the dry eye that can come with contact lens wear and obviates the preoperative peripheral iridotomy required for the previous version of the Visian lens. The EVO Visian ICL is indicated for use in phakic eye treatment in patients 21 to 45 years of age for the correction/reduction of myopia in patients with spherical equivalent ranging from -3.0 D to -20.0 D at the spectacle plane.

“The FDA approval of the EVO has made a lot more people interested in phakic IOLs,” Dr. Durrie says.

MEDICATIONS

Priya Vakharia, MD, noted two therapies in late stage of development: Apellis Pharmaceuticals’ intravitreal pegcetacoplan and Iveric Bio’s Zimura (avacincaptad pegol). Pegcetacoplan is an investigational, targeted C3 therapy, for the treatment of geographic atrophy (GA) secondary to AMD. It is designed to regulate excessive activation of the complement cascade, part of the body’s immune system, which can lead to the onset and progression of many serious diseases. Pegcetacoplan was granted Fast Track designation by the FDA for the treatment of GA.

Zimura is an investigational drug product that is a potential therapy for GA. It is designed to target and inhibit the cleavage of complement protein C5 and the formation of its downstream fragments, C5a and C5b. By inhibiting the formation of these fragments, Zimura is believed to decrease or slow the chronic inflammation and cell death associated with the retinal aging process by decreasing the formation of membrane attack complex and inflammasome activity, potentially avoiding or slowing the degeneration of retinal pigment epithelial cells.

“The results of these trials and potential approval of the therapies may represent the first treatments for GA and will be an exciting addition to the vitreoretinal space,” Dr. Vakharia says.

Laura Periman, MD, says she is excited for the pending FDA approval of Bausch + Lomb and Novaliq GmbH’s NOV03 (perfluorohexyloctane), an investigational, proprietary, water-free and preservative-free eye drop based on patented EyeSol technology from Novaliq. NOV03 has a unique mode of action that affects known abnormalities in the lipid layer of patients with dry eye disease (DED) associated with MGD.

“NOV03 rapidly spreads across the ocular surface because of its low surface/interfacial tension and interacts with the lipophilic part of the tear film, forming a layer at the tear film–air interface,” says Dr. Matossian. “The result of this is inhibition of evaporation of the aqueous phase of the tears.” NOV03 is currently under review by the FDA for the treatment of the signs and symptoms of DED associated with MGD.

Also from an ocular surface disease perspective, Dr. Periman noted Tarsus Pharmaceuticals’ TP-03 (lotilaner ophthalmic solution, 0.25%). TP-03 is a novel, investigational therapeutic designed to resolve the signs of Demodex blepharitis by targeting and eradicating the root cause of the disease: Demodex mite infestation. Lotilaner is a well-characterized agent that eradicates Demodex mites by selectively inhibiting the GABA-Cl channels. TP-03 was evaluated in two pivotal trials, and both trials met the primary endpoint and all secondary endpoints. TP-03 is also being studied for the treatment of MGD in patients with Demodex mites.

Dr. Donnenfeld says that TP-03, which is pending FDA approval, looks very promising. “This was the first time Tarsus had a booth at a major meeting and had a major event educating attendees about the importance of Demodex blepharitis.”

SURGICAL DEVICES AND TECHNOLOGY

2EyesVision’s SimVis Gekko provides patients with a non-invasive, personalized assessment of treatment. SimVis Gekko is a visual simulator of presbyopic corrections that provides a binocular real vision of the solutions available for presbyopia and cataracts. The specialist selects the different corrections to be tested then evaluates the patient’s performance at different visual differences and identifies the suitability of the patient for multifocal lenses.

“With the SimVis Gekko, you can show a patient simulated vision — for example, with a TECNIS Synergy (J&J Vision), PanOptix (Alcon), Vivity (Alcon) or any premium IOL — before they decide to do it,” says Dr. Jackson. “It will show what the vision is like at distance and near compared to a monofocal lens without glasses on.”

Ace Vision Group’s VisioLite Ophthalmic Laser System is a 2.94-um Er:YAG ophthalmic laser that is designed to perform laser scleral microporation (LSM). The procedure requires approximately 6-8 minutes per eye and can be performed in-office with little to no pain. Ideal candidates are at least 48 years of age with signs of presbyopia without cataracts in otherwise good ocular health. LSM is currently not available in the United States.

“The VisioLite looks like a modern day excimer laser or femtosecond laser and will deliver a treatment in under 14 seconds an eye for the treatment of presbyopia, treating the sclera,” says Dr. Jackson. “Ace Vision Group has already received 510(k) clearance for the device. The next step will be FDA studies to begin in 2023 for claims purposes with the use of the device.”

Marguerite McDonald, MD, FACS, says she was impressed with Bausch + Lomb’s Technolas TENEO excimer laser for LASIK vision correction surgery for hyperopia with astigmatism, which was on display at AAO 2022. TENEO is not currently FDA approved.

The Beyeonics One (BVI) exoscope is a high-definition fully digital imaging platform that enables surgeons to see a magnified, 3D image of the surgical field. It delivers enhanced visualization and on-demand consolidated preoperative information, which are accessible and controlled by an immersive augmented reality surgical headset.

“The exoscope system is unique compared to other heads-up/3D systems in that you are completely uncoupled from the operative microscope via use of a very advanced headset,” says Alanna Nattis, DO, FAAO. “With the headset on, you have the freedom of head movement (without worrying if you will tip off your 3D glasses) with truly exceptional images in real time. One of my fears with this new system was image lag-time, which could spell disaster in a complex case. But after one case, I felt I had gotten the hang of it — by the end of my surgery day it felt natural utilizing this device for my cases.”

LENSAR Inc.’s ALLY Adaptive Cataract Treatment System enables cataract surgeons to complete a femtosecond-laser-assisted cataract surgery (FLACS) procedure seamlessly in a single, sterile environment. ALLY provides Adaptive Intelligence to automatically determine cataract density, optimize fragmentation patterns and energy settings, with the goal of minimizing overall energy delivered to complete the cataract procedure more efficiently and help contribute to quicker visual recovery and better patient outcomes.

“The new ALLY system that was demonstrated at the booth was incredibly fast,” says Steven R. Sarkisian, Jr., MD. “With multiple cams to scan the eye, this femtosecond laser can do its full scanning and treatment in under a minute. Also, with an integrated phaco platform in the works, we may see a distinct uptick in the use of FLACS if there is no downtime.”

MYZE launched a new portal for patients for dry eye products, where a practitioner can send a patient to the site to buy individual or bundled packaged dry eye products and the product ships directly to the patient. “It’s no cost to the practitioner, and you don’t need to carry any inventory/set it up in the office as retail. You just send the patient to the site, and the products will ship directly to them. It makes life easier for the patient too as everything’s on one site,” says Dr. Jackson.

The ScoutPro Osmolarity System, from Trukera Medical, is the first portable osmometer in the United States. ScoutPro brings together nanoliter volume sample collection and analysis in a single portable device. Users can bring laboratory testing to patients anywhere in the practice to quickly test and provide objective results. Dr. Nijm says the ScoutPro can test tear osmolarity in the palm of your hand in 14 seconds, adding that it is efficient and user-friendly.

Vortex Surgical’s TID Pharos transscleral illuminator is a disposable illuminated scleral depressor with an integrated fiber optic that utilizes a larger fiber providing a significant illumination upgrade allowing more illumination to pass through the sclera. TID Pharos’ patent-pending “side-fire” technology allows for a better view, less glare and improved surgeon ergonomics. TID Pharos is designed to work with the light sources embedded in the majority of vitrectomy machines in the market.

“One of the challenging aspects of vitreoretinal surgery is the ability to achieve a good depressed peripheral shave without a skilled assistant,” says Dr. Vakharia. “The Vortex Surgical TID Pharos allows a retinal surgeon to use an illuminated depressor to achieve intraocular visualization and scleral depression at the same time, thereby allowing a solo surgeon to achieve a peripheral depressed shave without a skilled assistant.”

Dr. Nijm was impressed by the ZEISS Surgery Optimizer. The ZEISS Surgery Optimizer application was developed for surgeons as a way of utilizing surgical videos to enable self-training of physicians and standardization of surgical techniques.

“It uses AI to help improve your surgical skills, looking at each step,” says Dr. Nijm. OM