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Up Front | Feb 2015


Large Study Reports Lacs as Safe as Conventional Phacoemulsification

Laser-assisted cataract surgery (LACS) and standard phacoemulsification were equally safe procedures in a study published in the Journal of Cataract & Refractive Surgery.1

Five surgeons performed LACS (study group; n=1,852 eyes) or standard phacoemulsification (control group; 2,228 eyes) between May 2012 and November 2013 at the Tasmanian Eye Institute, Australia. Their technique included manual corneal incisions and capsulorrhexis or laser-assisted anterior capsulotomy, lens fragmentation, and corneal incisions, followed in both groups by phacoemulsification and IOL implantation.

Patient demographics were similar between the two groups. Over the course of the study, there was a significant improvement in vacuum/docking attempts, surface recognition adjustments, treatment, and vacuum time during the laser procedure in the study group. Anterior capsular tears occurred in 1.84% of eyes in the study group and 0.22% of eyes in the control (P<.0001). There was no difference in the incidence of anterior capsular tears between the first half and second half of laser-assisted cases. Anterior capsulotomy tags occurred in 1.62% of study group eyes. There was no significant difference in posterior capsular tears between the two groups (0.43% vs 0.18%). Although the incidence of significant intraoperative corneal haze and miosis was higher in the study group, the effective phacoemulsification time was significantly lower (P<.001).

“We found a statistically significantly higher rate of anterior [capsular] tears in the [LACS] group, and this was not related to the learning curve,” the study authors wrote. “There was, however, no between-group statistically significant difference in complications such as posterior [capsular] tear and dropped nucleus, which might be considered more clinically relevant for refractive outcomes and patient satisfaction. At present, there is a need for surgical benchmarks with regard to [LACS] complications so surgeons can better inform their patients of the risks and benefits of [LACS].”

1. Abell RG, Darian-Smith E, Kan JB, et al. Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: outcomes and safety in more than 4,000 cases at a single center. J Cataract Refract Surg. 2015;41(1):47-52.

Patients Perceived More Pain With Second-Eye Cataract Surgery

Nearly half of cataract patients reported the surgery in their second eye to be a more negative experience than the surgery in their first eye, according to a study in the Journal of Cataract & Refractive Surgery.1

Feisal A. Adatia, MD, MSc, FRCSC, of the University of Calgary and Mitchell Eye Centre, Canada, and colleagues conducted a prospective intraindividual observational study to examine the subjective patient experience after cataract surgery. Patients completed a questionnaire immediately after cataract surgery in their second eye. All patients underwent surgery in their second eye within 6 months of their first cataract surgery. Individuals whose surgery lasted longer than 30 minutes were excluded from the study.

Of the 292 patients who completed the questionnaire, 12 were excluded based on surgical time. The response rate varied per question. Compared with 13.5% of patients who rated their first cataract surgery to take longer and be more painful than the second surgery (P<.05), 45.4% identified the second surgery as the longer and more painful of the two procedures. About 40% of patients reported no difference between the first and second surgeries. Of patients who rated the second eye as the generally more negative experience, 47.83% thought their vision would be better, 3.48% thought it would be worse (P<.05), and 48.7% thought it would be the same. No difference was noted regarding the length of surgery (P=.3) or the sedation used (P=.96).

“We recommend preoperative counseling for all patients before their second cataract extraction, emphasizing that they may be more relaxed and have forgotten details of the first surgery; therefore, they may be more aware of the atmosphere of the operating room during the second procedure,” the authors wrote. “We would also counsel that there is less room for visual gain from the second surgery and that the improvement is often perceived to be less dramatic than after their first surgery.”

1. Adatia FA, Munro M, Jivraj I, Ajani A, Braga-Mele R. Documenting the subjective patient experience of first versus second cataract surgery. J Cataract Refract Surg. 2015;41(1):116-121.

Synergetics Acquires Sterimedix

Synergetics acquired Sterimedix for a net cash consideration of US$13.5 million, according to a company news release.

Sterimedix, a private manufacturing company incorporated in England and Wales, manufactures and supplies cannulas for ophthalmic and nonsurgical aesthetic procedures. Sterimedix generated total revenue of approximately US$6.4 million during its fiscal year ending December 31, 2013. Its sales are expected to grow approximately 15% on a constant currency basis for the calendar year ending December 31, 2014.

Imprimis to Launch Postoperative Eye Drop Formulation

Imprimis plans to release two combination topical drop formulations—triamcinolone acetonide plus moxifloxacin hydrochloride (Tri-Moxi) and prednisolone acetate and moxifloxacin hydrochloride (Pred-Moxi)—for use after laser refractive and cataract surgery as well as other surgical procedures, according to a company news release.

For high-volume surgeries such as PRK and LASIK, Imprimis estimates that its combination Tri-Moxi and Pred-Moxi topical eye drop formulations could require up to 50% fewer drops to be administered by patients and may cost up to 75% less than current postoperative drop regimens, the news release said.

According to Imprimis, its patent-pending drug formulations allow increased solubility of active pharmaceutical ingredients, creating small, uniform particle sizes that enable functionality such as an injectable, or use as a topical eye drop.

A prospective, investigator-initiated evaluation of Tri-Moxi and Pred-Moxi topical formulations for patients after LASIK was conducted in the fall 2014 at the Cleveland Eye Clinic. Imprimis expects results of this research to be available soon.


InSite Vision Enters License Agreement With Nicox

InSite Vision entered into a license agreement with Nicox for the development and commercialization of InSite's ophthalmic therapeutic products AzaSite (1% azithromycin), AzaSite Xtra (2% azithromycin), and BromSite (0.075% bromfenac), all formulated in InSite's DuraSite drug delivery system, according to a company news release.

The agreement grants Nicox exclusive rights to commercialize all three products in Europe, the Middle East, and Africa. Nicox expects to file European Marketing Authorizations for AzaSite and BromSite by first quarter 2016, with first commercial launch in late 2017. Under terms of the agreement, InSite will receive an upfront payment of US$3 million and up to US$13.75 million in milestone payments. Upon product launch, InSite will also receive tiered royalties.

AzaSite is approved in the United States and Canada for the treatment of bacterial conjunctivitis. BromSite is being developed for the treatment of inflammation and prevention of pain after cataract surgery. Nicox plans to target the same ophthalmic indications for AzaSite and BromSite in Europe, the Middle East, and Africa. The most appropriate indication and development path for AzaSite Xtra is under evaluation. Nicox will manage the further development required for registration of AzaSite and BromSite in Europe, the Middle East, and Africa.

No further clinical studies are expected to be required prior to filing marketing authorizations in Europe. A joint collaboration and development committee will oversee the development activities.

Ophthalmic Pioneer George O. Waring III, MD, FACS, FRCOphth, Dies at Age 73

Ophthalmic pioneer George O. Waring III, MD, FACS, FRCOphth, died January 27 at age 73.

Dr. Waring's career in ophthalmology spanned more than 30 years. Born in Buffalo, New York, Dr. Waring received his doctorate from Baylor Medical College in Houston, Texas. His ophthalmology training included a residency followed by a Heed Fellowship in corneal disease and surgery at the Wills Eye Hospital in Philadelphia.

Dr. Waring began his academic career in 1974, teaching at the University of California, Davis. There, he established the first eye bank in northern California. In 1979, he joined the faculty at Emory University, Atlanta, Georgia, where he later became a Professor Emeritus of Ophthalmology.

Dr. Waring was the Founder and Managing Director of the privately owned Vision Correction Group (Emory Vision/InView Vision Center) from 1994 to 2004. Starting in 2003, he practiced privately at the InView Center in Atlanta.

Among his many accomplishments, Dr. Waring's research included US National Institutes of Health grants to study radial keratotomy (as National Director of the PERK Study) and excimer laser corneal surgery. He presented the data to the FDA that led to the first FDA-approved clinical excimer laser vision correction surgery in the United States. As the principal investigator of the Emory-sponsored investigations of LASIK, he received the first physician-sponsored investigational device exemption from the FDA.

Dr. Waring published more than 500 articles and two textbooks. He received three American Academy of Ophthalmology (AAO) Honor Awards and the Lifetime Achievement Award from the International Society of Refractive Surgery (ISRS).

In addition to his ophthalmic accomplishments, Dr. Waring was known to enjoy sporting and outdoor activities. He was an avid skier and enjoyed squash, hiking, climbing, diving, and kayaking.

He leaves behind four children.

To view the EyewireTV coverage of Dr. Waring, visit http://eyewiretoday.com/tv/eyewiretv-mdash-ophthalmic-pioneer-george-waring-iii-passes-away-at-age-73/.

Presbia Appoints Todd Cooper President and CEO

Presbia appointed Todd Cooper its President and CEO, according to a news release. In this role, Mr. Cooper's priorities will focus on the expansion of Presbia's international operations, the completion of Presbia's ongoing FDA pivotal trial for its microlens, and, pending FDA approval, executing its launch in the United States. Mr. Cooper joins Presbia from his prior role as CEO of NVision, an operator of ophthalmic surgery centers.

Haag-Streit UK Named Sole UK Optovue Distributor

Haag-Streit UK is now the sole distributor of the Optovue product portfolio in the United Kingdom, according to a company news release. Haag-Streit UK will take over the UK distribution from Watford-based Grafton Optical, Optovue distributors since January 2007.

Haag-Streit UK will officially launch the Optovue iFusion and the new iScan at the 100% Optical event in London. The Angiovue OCTA system and XR Avanti will be showcased during the Royal College of Ophthalmologists annual congress in Liverpool in May.

Rayner Implements Changes to Senior Management Team

Rayner Intraocular Lenses implemented several changes to its senior management team, according to a news release. The team now includes Tim Clover, Joint CEO and New Projects Director; Darren Millington, Joint CEO and CFO; and Andrew Webb, Global Vice-President, Commercial.

 These appointments reflect renewed focus on Rayner's surgical business following the divestment earlier last year of Rayner's retail optometry business, the company said. The change will be complemented by a move later this year to the Ridley Innovation Centre, a new global headquarters and production facility in Worthing, West Sussex, United Kingdom. n


1. Anticholinergic Drug Use Linked to Dementia

People who took strong anticholinergic drugs daily for long periods were more likely to develop dementia.

2. Daytime Electronic Device Use Disrupted Sleep

Spending more than 2 hours per day on electronic devices was associated with a longer time to get to sleep and a shorter amount of sleep through the night in adolescents.

3. Members of UK Parliament Say Yes to Three-Person Embryo Law

Members of Parliament voted in favor of the creation of babies with DNA from two women and one man, a technique that prevents deadly genetic diseases being passed from mother to child.

4. Personalized Medicine to Reduce Adverse Drug Outcomes in People With Mental Illness

A new research initiative aims to reduce or prevent adverse drug effects in people with mental illnesses.

5. Opioid Use in Women Raises Birth Defects Fears

Exposure to opioid painkillers increases a baby's risks for major defects in the brain and spine, congenital heart defects, and problems with the abdominal wall.

–Compiled by Steve Daily, Executive Editor, News;
and Callan Navitsky, Senior Editor