Steroids helpful for DME

For patients with diabetic macular edema (DME), intravitreal triamcinolone (IVTA) was able to improve vision in eyes that had continued to deteriorate despite receiving standard laser treatment, researchers at the University of Sydney, Australia, said in a university news item.  In the first three months after treatment, the patients initially treated with both IVTA and laser showed significantly better gains in vision than control group patients who were treated with laser only. After 2 years, patients in the original control group were also treated with IVTA. The beneficial effects persisted in most IVTA-treated patients throughout the 5-year study; however, 80% of patients in the initial IVTA group developed elevated intraocular pressure and 56% of them required therapy, the university said. Also, two-thirds of all patients required during the study period. Similar outcomes have been noted in other studies of steroid-based treatment and thus were not considered new safety concerns by the group.

Bausch & Lomb Introduces the Crystalens® Aspheric Optic (AO) Lens

Bausch & Lomb today announced that it is launching the Crystalens® AO, the first aberration-free accommodating intraocular lens (IOL) with aspheric optics to cataract surgeons worldwide.

Alcon to Enter Surgical Glaucoma Market by Acquiring Optonol

Acquisition reflects increasing importance of glaucoma surgery to preserve visionEntry into glaucoma surgery provides additional near term growth opportunity for AlconHUENENBERG, Switzerland, Dec 14, 2009 (BUSINESS WIRE) — Alcon
(NYSE:ACL)
announced today that it has entered into a definitive agreement to
acquire Optonol, Ltd., a medical device company that develops,
manufactures and markets novel miniature surgical implants used to lower
intraocular pressure (IOP) in patients with glaucoma. With this
acquisition, Alcon will acquire Optonol’s Ex-PRESS(TM) Mini Glaucoma Shunt.
This agreement will complement Alcon’s pharmaceutical produc…

Iluvien study shows promising early results

The 18-month results from the first human pharmacokinetic study (PK Study) of Iluvien in patients with diabetic macular edema has found the compound safe, licensee Alimera Sciences (Atlanta) said in a news release. Iluvien delivers fluocinolone acetonide (FA) for the treatment of diabetic macular edema (DME). Formerly known as Medidur FA for DME, Iluvien is in fully recruited Phase III clinical trials, developer pSivida Corp. (Watertown, Mass.) said in a separate news release. Alimera’s 36-month, open-label, Phase II study, running concurrently with the pivotal Phase III FAME Study (Fluocinolone Acetonide in Diabetic Macular Edema), is designed primarily to assess systemic exposure of the corticosteroid FA, after administration of Iluvien in patients with DME.

There were a total of 37 patients enrolled in the PK study, 20 patients on the low dose of Iluvien (an approximate 0.23 μg per day dose), and 17 patients on the high dose of Iluvien (an approximate 0.45 μg per day dose). In the high dose group, 55% had at least a 10 letter improvement in best corrected visual acuity from baseline, and 36% achieved an improvement of 15 letters or greater. In the low-dose group, 23% had an improvement in BCVA of at least 10 letters from baseline, but none had an improvement of 15 letters or more. Intraocular pressure increases were not affected by the low dose version, but the high dose version yielded 29% with an IOP increase to 30 mm Hg or more. Iluvien is an extended release intravitreal insert designed to provide a sustained therapeutic effect of up to 36 months, for the low dose of Iluvien, and up to 24 months for the high dose of Iluvien. Iluvien is inserted into the patient’s eye with a 25-gauge needle, allowing for a self-sealing wound.

Hoya Surgical Optics Enters US Marketplace

Hoya Surgical Optics based in Chino Hills, California is a global company focused on meeting the needs of surgeons and patients worldwide.  They are the world’s 4^th largest intraocular lens (IOL) manufacturer and distributor. Hoya Surgical Optics leverages more than 65 years of experience in precision optics technology into the design and manufacture of IOL’s.

Hoya Surgical Optics has recently gained FDA clearance for its IOL’s and iSert pre-loaded IOL System and looks to gain market share via a competitive portfolio of lenses and pre-loaded IOL Systems.  The company is offering spherical and aspheric acrylic lenses with a multifocal lens currently being offered outside the United States.

The AF-1 iSymm Acrylic Lens delivers the proprietary Aspheric Balanced Curve Design, advanced blue light absorbing technology, and 360-degree step-edge design.  This lens has a 6.0mm optic and has received New Technology Intraocular (NTIOL) designation from the Centers of Medicare and Medicaid Services .  The AF-1 iSpheric IOL delivers reliable visual outcomes through proven design, materials, and manufacturing. The lens provides a smooth optical surface coupled with design features that minimize optic deformation and provides excellent intracapsular stability.  The iSert preloaded IOL system has been designed to fit through a sub 2.5mm incision.  This pre-loaded system is easy to use and saves time for the surgeon and staff.

Hoya Surgical Optics has also recently announced the introduction of the Smart Automated Inventory Management system, “SAMI” as part of their customer care technologies and services. Using advanced radio frequency identification (RFID) technology, SAMI provides automated lens reordering as well as real-time, automated inventory management designed to reduce costs associated with reordering IOLs along with increased assurance of avoiding stock-outs for ophthalmic practices.

The Future of Surgery

Today, robotics has pushed on the boundaries of medicine to be accepted as trusted devices in the operating room.  The new “Da Vinci” system has had a high impact into the surgical world allowing surgeons, controlling robotic arms and viewing three-dimensional images, while operating through micro incision entry points.

To see more click here

Microrobots are on the horizon as well.  Miniature robots that are swallowed to gather information and/or images so more accurate and perhaps fewer incisions for the patient.

To see more click here

As new technology evolves, the cataract procedure keeps evolving as well.  Smaller incisions, instruments, intraocular lenses keep pushing forward the newest techniques.  NASA has even provided new technology that can detect the formation of a cataract before it is clinically visible, thus a camera predicting the future arrival of a cataract.

To view the PDF please click here.

As the future of surgery, our greatest challenges will still be, to maintain the highest level of surgical outcomes while justifying the return on investment for hospitals and surgical centers.  As our future looks so ever exciting in the world of surgery we dare to look behind at what cost will be following.

Alcon Posts 5.9 Percent Sales Growth for Third Quarter

Third Quarter Highlights

Organic sales growth was 9.0 percent

Operating profit rose 17.0 percent to $578 million

Sales of advanced technology intraocular lenses increased 34.2
percent

Management raises outlook for full year earnings per share

HUENENBERG, Switzerland–(BUSINESS WIRE)–Oct. 27, 2009–
Alcon, Inc. (NYSE:ACL) reported global sales rose 5.9 percent to $1,614
million for the third quarter of 2009, or a 9.0 percent increase
excluding the impact of foreign exchange fluctuations. Net earnings for
the third quarter of 2009 …

Multifocal IOLs-Adverse Visual Effects and Their Treatment

Multifocal IOLs-Adverse Visual Effects and Their Treatment

Monofocal intraocular lenses (IOLs) have long been the standard in lens replacement after cataract removal.  However, in the last few years multifocal IOLs have established a firm presence in the marketplace.  Monofocal IOLs can only be used to give a single defined focusing point.  This allows a patient the choice to either see distance or close up. Therefore glasses must be used to correct either the presbyopia or myopia.  Multifocal IOLs, of course, allow for multiple areas of focus and allows for spectacle independence.  Although multifocal intraocular lenses appear to be an easy choice for a patient, there have been problems associated with these types of IOLs such as halos, reduced contrast sensitivity, and blurred vision.  These symptoms, though troubling to the patient and the surgeon, have been shown to be resolved the majority of the time.

OSN Super Site recently cited a study in which it was shown, that of 43 eyes included in the study approximately 81% achieved improved vision after a conservative treatment regimen, 7% improved after IOL exchange, and only 12% showed no improvement.  The treatments included excimer, drug therapy, laser iridioplasty, and YAG laser capsulotomy.  The authors of the study, as well as Dr. Jay Pepose in the review of the OSN article stated that YAG capsulotomy should be one of the last treatment choices.  This is due to the possibility the YAG not being effective and if an IOL exchange needs to be done the capsular bag is now compromised and it makes for a much more difficult procedure.  Further studies have shown that patients that have had multifocal IOL implantation may need a 6 month neuroadaption period.  This simply means that the brain needs adequate time to develop or alter neural pathways to improve visual function after the IOL has been implanted.

Although Multifocal IOLs have been shown to have certain post op adversity, one can’t deny the success they have had in freeing a patient from being tied to their glasses.  Nearly all patients either receive treatment or neuroadaptation takes place to accommodate for the multifocal IOL and the adverse visual effect are resolved.  Patient satisfaction and positive outcomes are always the wishes of the surgeons implanting these IOLs.  Proper patient education in the rewards, possible adverse effects, and the treatments of these adverse effects are essential when planning to implant a multifocal IOL.

Bausch & Lomb’s Crystalens® to be Featured in Direct-to-Consumer Advertising

Bausch & Lomb announces that a direct-to-consumer advertising campaign will resume today (September 14) about Crystalens®, the nation’s only FDA-approved accommodating intraocular lens (IOL).

A True Vision: Vision Blue

The delicacy required when performing cataract extraction is truly amazing.  The skill and steadiness of the surgeon’s hands are something to truly admire.  One of the most precise, and important aspects of the cataract extraction procedure is the performance of the capsulorhexis.  When faced with a mature cataract or even perhaps a small pupil this part of the procedure becomes increasingly difficult.  One way to counter this issue is the technique of capsular staining to clearly define the anterior capsule.  When this technique is employed the clear choice for most surgeons is to use Vision Blue (.06% Trypan Blue Ophthalmic Solution).

Although capsular staining had been being performed worldwide for a number years, it wasn’t until late 2004 before DORC International received FDA approval in the United States for their product Vision Blue.  This approval allowed US surgeons to finally have a resource that could help with performing a capsulorhexis in less than ideal conditions.  Before the use of Vision Blue, a surgeon may have experienced the inability to adequately visualize the anterior capsule which can result in an incomplete capsulorhexis.  With Vision Blue, the risk of radial capsule tears and other complications are greatly diminished.

The administration of Vision Blue during a cataract extraction procedure is very simple.  The stain is already sterilely packaged in a 2.25ml syringe in which a blunt cannula is attached.  Following the initial incisions, an air bubble is injected into the anterior chamber.  This is done to minimize any dilution of the Vision Blue by the aqueous.   Once the air bubble is injected the surgeon simply applies the stain with the blunt cannula to the anterior lens capsule.  The chamber is then irrigated to eliminate excess and the capsulotomy can be performed.

Vision Blue has been shown through a number of studies to be safe and with very minimal adverse reactions associated with it.  It was shown to have discolored hydrophilic acrylic intraocular lenses and also noted to inadvertently stain the posterior capsule and vitreous.  The use of Trypan Blue should be avoided if using a hydrophilic IOL.  In terms of the posterior capsule and vitreous staining, the discoloration gradually fades and is gone within a weeks time.

With the introduction of Vision Blue into the US market, surgeons have gotten to enjoy the ability to get much needed assistance when performing procedures in which the anterior capsule is associated with a mature cataract or small pupil.  Capsular staining makes the capsulorhexis an easier and safer task when dealt   with such situations.  Ultimately, Vision Blue allows for a much safer procedure and higher quality outcomes for the patient which is a win-win scenario for all involved.

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