Laird Harrison

April 28, 2017

New types of intraocular lens, femtosecond laser, collagen cross-linking, and microinvasive glaucoma surgery (MIGS) will feature prominently at the upcoming American Society of Cataract and Refractive Surgery (ASCRS) 2017 Annual Congress.

Researchers are making steady progress in these and other technologies for restoring eyesight to people with presbyopia, cataracts, and glaucoma, said Edward Holland, MD, from the University of Cincinnati, Ohio, who is the program chair.

The ASCRS meeting, which is combined with the annual meeting of the American Society of Ophthalmic Administrators (ASOA), takes place May 5-9 in Los Angeles, California.

Dr Holland is particularly watching developments in accommodating intraocular lenses (IOLs). Standard IOLs implanted in cataract surgery can focus on either near or distant objects. Multifocal IOLs allow clear vision at a variety of distances, but with an increased risk for haze and glare.

IOL designers are now working on accommodating IOLs, the refractive properties of which could be changed by the ciliary muscles in the same manner as natural lenses. "I think we've seen tremendous benefits from multifocal IOLS and, despite multiple efforts by multiple companies to increase the market, it's flat," Dr Holland told Medscape Medical News. "It's flat because there are significant drawbacks to multifocal IOLS. A true accommodating IOL would be a breakthrough."

Robert Edward T. Ang, MD, will present data from a 5-year head-to-head trial in which his team randomly assigned 156 eyes to the accommodative Crystalens AO IOL (Bausch + Lomb), the AcrySof IQ ReSTOR +3.0 D multifocal IOL (Alcon), or the Tecnis Multifocal IOL (Abbott).

The Crystalens is not the only accommodative lens in town: Louis D. Nichamin, MD, will present a pilot study of the FluidVision Accommodating Intraocular Lens (PowerVision Solution).

The two works accommodate IOLs on different principles. The Crystalens changes its focus by moving forward and backward on its flexible, hinged haptics. In the FluidVision lens, when the zonules release tension on the capsule, it compresses two large haptics, which push a silicone fluid between two optics.

Another approach to changing the refractive properties of implanted IOLs is through the use of femtosecond lasers, said Liliana Werner, MD, PhD, a program committee member from the University of Utah in Salt Lake City.

The approach could be used on standard acrylic hydrophobic IOLs to correct for residual refractive errors, astigmatism, and higher-order aberrations, or even to produce multifocality. "This technique has the potential to significantly expand the use of femtosecond lasers in cataract/refractive surgery, and clinical trials are apparently ready to start soon," she told Medscape Medical News in an email.

In one presentation at this meeting, Ruth Sahler, from Perfect Lens of Ruprecht-Karls-Universität in Heidelberg, Germany, will explain how researchers there were able to change the refraction of an implanted lens and then change it back again with good modulation transfer function.

Researchers at this meeting are also exploring another application for lasers: removing cataracts. Gangolf Sauder, MD, from Charlottenklinik for Ophthalmology in Stuttgart, Germany, will describe a comparison of nanolaser surgery to phacoemulsification.

Another hot topic at the meeting  will be new applications of collagen cross-linking, said Dr Holland. Suphi Taneri, MD, from the Center for Refractive Surgery in Muenster, Germany, will describe a trial of the procedure for the treatment for myopia. Others, including Bhupesh Singh, MBBS, DO, from Bharti Eye Hospital in Delhi, India, will describe how it can be combined with LASIK.

Other presentations, including one by Philip T. Hagen, MD, from the Mayo Clinic in Rochester, Minnesota, will compare LASIK with small-incision lenticule extraction (SMILE). "SMILE has been in Asia, but US surgeons are just starting to do it," Dr Holland said.

Glaucoma specialists will also find much to discuss. "We think this is going to be a great program for the comprehensive glaucoma specialist who is looking for practical information," Douglas Rhee, MD, from the University Hospitals Case Medical Center in Cleveland Ohio, told Medscape Medical News. The presentations will include "lots on MIGS that's the newest stuff. Not just the first-generation MIGS, but even the ones that have just been [released by the US Food and Drug Administration]. We comprehensively cover all of them."

Dr Holland and Dr Rhee have disclosed no relevant financial relationships. Dr Werner disclosed relationships with Advanced Vision Science, Alcon, Anew Optics, ClarVista Medical, CoDa Therapeutics, Cord, Genisphere, Hoya, LensGen, Medicontur, Mynosys, Omega, PerfectLens, Powervision, Sharklet, Shifamed, and Zeiss.

American Society of Cataract and Refractive Surgery (ASCRS) 2017 Annual Congress.

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