Excitement builds over several refractive presentations

From non-IOL presbyopic options to corneal crosslinking to femto- second lasers, this year’s ASCRS refractive presentations promise to offer something for everyone

There is always plenty to see and listen to at the American Society of Cataract and Refractive Surgeons’ meeting, but this year the excitement seems to be in refractive more so than other areas. This year’s conference boasts around 40 courses, more than 350 papers and 150 posters, and eight symposia on the topic. Add another two wet labs, and attendees may have difficulty cramming it all into the time allotted. The increasing use of the femtosecond laser beyond refractive surgery is among the topics Richard L. Lindstrom, M.D., adjunct professor emeritus, Department of Ophthalmology, University of Minnesota, Minneapolis; founder, Minnesota Eye Consultants, Minneapolis; and member of the ASCRS Refractive Clinical Committee, is anticipating.
“Certainly, one of the most exciting things we’ve seen with the femtosecond laser are all the additional indications being sought or achieved, which now includes cataract surgery capsulorhexis, nuclear softening, incision creation, as well as the current keratoplasty indications,” he said. In refractive, the femtosecond laser “is now being used to treat myopia, hyperopia, astigmatism, and presbyopia.”
Dr. Lindstrom is presenting on his personal experiences with the iFS femtosecond laser (Abbott Medical Optics, Santa Ana, Calif.). He said the higher repetition rate allows this generation to reduce its raster energy and suction time. “The refractive effects of the femtosecond laser in applications outside of refractive surgery are intriguing,” he said.
Saying he expects a lot of presentations and buzz in the hallways about the many femtosecond laser presentations, “not only the advancements in the IntraLase [AMO] but also about what Ziemer [Port Switzerland] is doing, as well as WaveLight [Alcon, Fort Worth, Texas] and Perfect Vision [St. Louis],” said Daniel S. Durrie, M.D., clinical professor of ophthalmology, University of Kansas, Overland Park, Kan.
The whole femtosecond field will be a “hot topic,” Dr. Durrie said, “including all the strategies on how to use it for cataract surgery. That’s going to be a hot discussion topic.”
He said new information from companies like LenSx (Aliso Viejo, Calif.), LensAR (Winter Park, Calif.), and OptiMedica (Santa Clara, Calif.) will add to the overall topic of femtosecond laser use. “Excimer lasers are certainly the mainstay of what we’re using, and a lot of us are well-educated on the femtosecond laser as well,” he said. “I think moving forward we’ll be making purchasing decisions based on what fits into your own personal business plan. This is a very exciting time to be in the laser business.”
Acknowledging AMO is “still the market leader in the femtosecond market, as more competition enters the field, that will force more innovation to happen. The overall market as a whole will grow when more technologies are introduced.”
According to Capt. (Ret.) Steven C. Schallhorn, M.D., San Diego, and medical director, Optical Express, London, some of the hotter topics he expects to be dominant this year include non-IOL presbyopic options. “I’m looking forward to hearing more about the AcuFocus study as that clinical trial matures and progresses,” he said. Collagen crosslinking will continue to be a focus of interest, he said, and some of the early results from the U.S. crosslinking study might be available. Finally, he said, attendees should expect an update on what the Food and Drug Administration is doing on LASIK. (In December, the FDA said it was re-opening its public docket information and comments on LASIK devices, now accepting public comments through Nov. 15, 2010. The docket had previously closed in Sept. 2009.) “They’re conducting a study in combination with the Department of Defense in San Diego,” he said. “LASIK surgeons have been paying attention to the little details that are beginning to emerge from this study.”
At last year’s ASCRS conference, Kerry D. Solomon, M.D., Arturo and Holly Melosi Professor of Ophthalmology, Medical University of South Carolina, Charleston, S.C., and ASCRS co-chair of the Joint LASIK Study Task Force, presented conclusions from a meta-analysis of LASIK studies from around the world and found LASIK had one of the highest post-surgical ratings, with a 95.4% patient satisfaction rate worldwide. At the time of his presentation, Dr. Solomon noted those rates were consistent over the 10 years the Task Force analyzed studies. The meta-analysis identified 19 studies published in the 10 years previously that specifically tracked satisfaction rates. Dr. Schallhorn said refractive surgeons will need to be vigilant about responding about the FDA/DoD study once some of the parameters are better clarified.

Editor’s note: Dr. Lindstrom has financial interests with Abbott Medical Optics (Santa Ana, Calif), LenSx (Aliso Viejo, Calif.), and LenAR (Winter Park, Fla.). Dr. Schallhorn has no financial interests related to his comments.

Contact information

Durrie: 913-491-3330, ddurrie@durrievision.com
Lindstrom: 952-567-6051, rllindstrom@mneye.com
Schallhorn: 858-695-3849, steveschallhorn@opticalexpress.com