Old meets new in cataract, refractive surgery symposium

April 18 - Washington, DC - Ophthalmologists discovered something "new" and something "old" Sunday evening during the "Innovations in Cataract and Refractive Surgery" symposium, sponsored by the Dulaney Foundation and supported by an educational grant from Alcon Laboratories.

Attendees learned of "new" technologies and the continuous advances in cataract and refractive surgery during an educational program at the Andrew W. Mellon Auditorium. Afterwards, the participants were treated to a reception at the Smithsonian's National Museum of Natural History-amidst everything "old."

The program, moderated by Stephen S. Lane, MD, of St. Paul, MN, covered advanced laser technology, new developments in topical therapeutic agents, successful pearls with an apodized diffractive IOL, and new technologies in improving surgical outcomes.

Daniel Durrie, MD, of Overland Park, KS, began the program by reviewing a brief history of refractive surgery, outlining the basics of wavefront technology and how Alcon's LADARVision and Custom Cornea fit into the wavefront area.

In an effort to clarify misconceptions concerning wavefront algorithms, Dr. Durrie also outlined the definitions between wavefront-guided and optimized. He added that registration is truly customized surgery because it covers refractive surgery all the way across the board.

Dr. Durrie concluded his presentation by describing the features of the LADARVision 6000, the latest laser by Alcon that was introduced at the ASCRS meeting. The laser is practically "90% new under the covers."

Edward Holland, MD, of the University of Cincinnati followed with the latest developments in topical therapeutic agents. Dr. Holland outlined the clinical goals of NSAIDs and their role in the prevention of CME, especially after cataract surgery.

Dr. Holland also discussed the clinical data of new NSAID in clinical trials called Nepafenac, The drug is said to penetrate the intraocular tissues and has the highest penetration of all NSAIDs in clinical trials. It also has fewer complications than the other NSAIDs. The drug also reduces anterior segment inflammation associated with cataract surgery.

L. Jay Katz, MD, of the Wills Eye Hospital, Philadelphia, shifted direction in the program by discussing compliance issues in glaucoma. He established the difference between compliance and adherence and how compliance in glaucoma management really affects low-income individuals.

After providing statistics as to the number of glaucoma patients expected to lose their vision by the year 2020 (between 175,000 to 265,000 in the United States, and 6 to 7 million worldwide), Dr. Katz offered some reasons for non-compliance (forgetfulness is number one) and the critical factors that affect adherence. Dr. Katz also offered solutions for poor adherence and some strategies for success.

Miquel N. Burnier Jr., MD, an ophthalmologist and pathologist at McGill University, Montreal, presented some disturbing data that showed a clinical relationship between cataract surgery and IOLs and ocular melanoma. Dr. Burnier outlined the prognostic factor in the cell types of uveal melanoma and how they are different from other cell types within the eye. He also outlined the risk factors of uveal melanoma, and added that cell rates exposed to blue light from the blue light spectrum can develop into ocular melanoma.

Dr. Burnier pointed out that in vitro experiments have proved that blue light can induce malignant transformation within the eye following cataract surgery. As a pathologist, he recommended the use of ultraviolet and blue light-blocking IOLs as preventive measure against possible blue light-induced malignant transformation.

Kerry Solomon, MD, of the University of South Carolina, discussed the ReSTOR apodized diffractive lens, recently approved by the FDA and has drawn physician interest at the ASCRS meeting. Dr. Solomon describerd the unique features of the lens and presented vision acuity data on 500 eyes implanted with ReSTOR.

Dr. Solomon also provided significant results of a Reader Performance Study that analyzed ReSTOR patients in actual reading situations. The study found patients with ReSTOR outperformed other lenses in functional vision, including areas like reading computers, shopping, reading labels, etc.

One of the highlights of program was Takayuki Akahoshi, MD, of Japan, who presented a video of his sub-2-mm coaxial phacoemulsification technique and lens implantation. Utilizing the Infiniti phaco system with AquaLase, Dr. Akahoshi demonstrated how he utilized a new NANO sleeve with 3 irrigation ports through 1.7 mm incision, extracted a cataract from a patient's eye, and inserted a 6-mm AcrySof IOL.

Susan MacDonald, MD, of Tuft University, Boston, concluded the program by highlighting the advantages if the Infiniti phaco system and focused on three new advances to the unit.

Dr. MacDonald pointed out that the Infiniti stabilizes the anterior chamber, offers greater holding power, with less chatter in the anterior chamber, and offers dramatic reduction in phaco time (by 75%) and phaco power (by 50%).

The three new advances are less compliance (benefits of low compliance), two pressure sensors (infusion and irrigation sensors), and silence of the unit, most notably in the pulse, hyper-pulse, burst, and duty cycle modes.