April 2007




Unique solutions to common problems...at this year’s symposium

by Michelle Dalton EyeWorld Contributing Editor


A foldable phakic IOL and innovative uses of light treatments will be discussed

Presentations at this year’s ASCRS Symposium on Cataract, IOL and Refractive Surgery will include innovative techniques and technologies that will be new to many U.S. surgeons. European surgeons will present their experience with the foldable Artiflex (Ophtec BV, Groningen, Netherlands) phakic IOL. U.S. surgeons have access to the rigid PMMA version of this lens, distributed as the Verisyse by Advanced Medical Optics (AMO, Santa Ana, Calif.), but the foldable version has not yet been approved by U.S. regulators. Several European surgeons will discuss their use of the foldable lens in a course titled “Iris-Claw Phakic IOL: Present and Future,” on Saturday, April 28, beginning at 1 p.m.

Foldable phakic IOL

Roberto Pinelli, M.D.

Roberto Pinelli, M.D., Brescia, Italy, will be one of the faculty members at the Saturday course on iris-fixated phakic IOLs. He said he believes the use of this type of phakic IOL will increase in coming years because of its efficacy and its safe track record.

“The most exciting experience with the iris-claw phakic IOLs is to use the foldable version,” Dr. Pinelli said. “Now, 99% of the iris-claw phakic IOLs that we implant are foldable.”

He said the use of topical anesthesia, sutureless closure and bilateral implantation, as well as the low number of complications and resulting high-quality post-op vision, result in a high level of patient satisfaction with the Veriflex. He called the foldable lens “really a new planet in refractive surgery.”

The indications for use of the Veriflex include myopia from –5 D to –15 D with or without astigmatism and hyperopia from +3 D to +9 D with or without astigmatism, Dr. Pinelli said.

“In my experience, most of the candidates for iris-claw phakic IOLs are myopic patients because in the hyperopes the anterior chamber depth is usually not sufficient,” he said. The minimum anterior chamber depth requirement for the lens is 3 mm.

Dr. Pinelli said the safety concerns with this style of anterior chamber phakic IOL seem to have been settled, “thanks to the studies of many colleagues.”

“In my experience, I never had cataract after the implantation of an iris-claw phakic IOL, nor corneal decompensation,” he said.

One focus of the course will be “the new frontiers of this technology and technique,” Dr. Pinelli said. The use of small-incision, bilateral surgery with topical anesthesia will be emphasized. For the future, he said, “Don’t forget that, theoretically speaking, we could also think of multifocal phakic IOLs for presbyopia.” The phakic IOL course will be led by H. Burkhard Dick, M.D., Mainz, Germany. Other faculty members in addition to Dr. Pinelli will include Y. Ralph Chu, M.D., Edina, Minn.; and Jose L. Gьell, M.D., Barcelona, Spain.

Light treatments for dry eye

Another innovation that will be discussed at the meeting is the use of dermatologic light treatments — intense pulsed light (IPL) and broadband light (BBL) — for patients with dry-eye syndrome.

Rolando Toyos, M.D., Memphis, Tenn., will discuss his experience using non-laser light sources to treat dry eye in Session 3-A, Corneal Therapies, on Monday, April 30, beginning at 8:00 a.m.

According to Dr. Toyos, IPL and BBL have been effective in treating patients with dry eye of non-immune etiology. IPL and BBL are more commonly used in dermatology to treat rosacea. Dr. Toyos said he is the first to investigate the use of these light treatments for dry eye.

“It started when some of my rosacea patients began IPL treatments for their skin condition,” he said. “IPL eliminates superficial blood vessels of the face. We administered these treatments in our aesthetic clinic. These patients would come back to our eye clinic and tell us that their eyes felt great.”

The treatments had improved meibomian gland function in these patients, Dr. Toyos said, so he began applying the technology to patients with dry eye and found similar results.

In the data to be presented at the ASCRS meeting, Dr. Toyos said, no significant difference was seen between the two treatments. Both treatments increased tear break-up time and the results of Schirmer’s test with anesthesia. Contralateral eyes not receiving treatment also showed improvement with both modalities, but not as much improvement as treated eyes.

Dr. Toyos said the treatments have a “strong potential” for use in treating dry-eye syndrome.

“We have been trying to refine the technique and parameters so that any ophthalmologist will feel comfortable performing the procedure,” he said. “So a doctor can purchase the technology and specifically use it for dry eye, or if they feel more comfortable they can send their dry-eye patients to the local dermatologist for treatment.”

Eye on Fire

Rolando Toyos, M.D.

Jerre M. Freeman, M.D., has correlated ocular findings to systemic inflammatory disease by evaluating common systemic diseases (such as coronary artery disease, atherosclerosis, arthritis, diabetes, neurodegenerative conditions, Alzheimer’s and chronic diseases of the eye) and their inflammatory antecedents. It is vital to understand the relationship between systemic inflammatory conditions that directly and adversely affect ocular health, he said.

Dr. Freeman illustrated with an example, “diabetes has the potential for microhemorrhages or hemorrhages of vessels in the retina that can lead to a loss of vision.” Coronary artery disease, as another example, has been connected with certain inflammatory markers such as elevated C-reactive protein and homocysteine. Age-related macular degeneration (AMD) has been shown in some studies to be connected to elevated C-reactive protein and homocysteine. “So, one would expect a correlation between AMD and coronary artery disease/atherosclerosis occurring in the same patient,” he said. “If both are connected with inflammation, the physician/ophthalmologist that diagnoses one of these conditions in a patient should be aware there is a high incidence of the other condition also being present in the same patient.”

When patients present with local inflammatory conditions such as dry eye, Dr. Freeman said patients who show improvement in their dry eye state “will also report improvement of symptoms of such conditions as systemic arthritis, also an inflammatory condition.” Systemic nutritional supplements prescribed to reverse inflammatory conditions in the eye may also favorably affect other inflammatory conditions at other sites within the human body, he said. Dr. Freeman suggests ophthalmologists should work closely with a patient’s primary care physician and other specialists when treating a patient with systemic diseases. “Ophthalmologists are first trained as physicians, and we are calling ophthalmologists back to their roots – to be physicians first,” he said. “The old phrase, ‘What is good for the goose is good for the gander’ applies to this situation – what is good for the body is good for the eye and vice versa.”

Dr. Freeman is slated to discuss these correlations between ocular findings and systemic inflammatory disease, in a clinical retina course entitled “Eye on Fire”that will be presented on Monday, April 30 from 3:00-4:30 p.m. The goal for attendees, Dr. Freeman said, is to become more aware of the need for ophthalmologists to consider the overall health status of their patients as they provide ophthalmological care.

Editors’ Note: Dr. Freeman is a speaker for Biosyntrx (Lexington, S.C.), Eaglevision (Memphis, Tenn.), and Occulogix (Palm Harbor, Fla.). Neither Dr. Pinelli nor Dr. Toyos have any financial interests related to this article.

Contact Information

Pinelli: +001 39 030 2428343, pinelli@ilmo.it

Toyos: 731-660-3937, rostar80@aol.com

Freeman: (901) 767-3937; jmfeagle@mecavision.com

Unique solutions to common problems...at this year’s symposium Unique solutions to common problems...at this year’s symposium
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