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Up Front | Jun 2016


Annual Global IOL Procedures Expected to Top 30 Million by 2021

According to a report from Market Scope,1 global IOL procedures are expected to climb to 30.3 million by 2021, at a compounded annual rate of 3.6%. Market Scope’s 2016 IOL Report includes market data for 2015 and 5-year forecasts for cataracts and cataract surgery worldwide. The global IOL market was analyzed using eight regional/economic categories: the United States, Western Europe, Japan, other wealthy nations, China, India, Latin America, and the rest of the world.

Factors contributing to growth in the IOL market are steady growth of an aging population, the availability of enhanced monofocal and premium IOLs, robust demand for improved visual outcomes, and growing worldwide access to advanced medical technology, according to a news release. The fastest growth is anticipated in developing countries and regions, such as China, India, and Latin America, with the highest population growth rates, in addition to relatively large population groups with cataracts that have not been surgically addressed.

Skyrocketing health care costs in the face of a global recession have forced many countries to adopt austerity measures that have slowed growth in cataract surgeries. Despite this, Market Scope anticipates steady growth over the next 5 years. The news release stated that austerity measures tend to cause a buildup in the cataract surgery patient backlog over time and will have little effect on the global average yearly increase in cataract surgeries. Furthermore, most IOL market growth is expected to come from increased selling prices related to improvements in IOLs entering the market.

Enhancements to IOLs are likely to include an increased number of multifocal optic designs, greater variety of toric optics, an increased number of multifocal and accommodating toric IOLs, and new accommodating IOLs with greater accommodative ranges. Also expected are improved aspheric and wavefront-designed IOLs, IOLs with postoperative adjustability, extended depth of focus IOLs, and IOL optics that are free of glistenings. Additionally, more IOLs that filter visible blue light; phakic IOL enhancements, including toric and multifocal optics; combination IOLs that incorporate a number of the above technologies; add-on sulcus-fixated IOLs to improve postoperative cataract outcomes; and IOLs designed to take full advantage of the precision of laser-assisted cataract surgery are all expected. Market Scope also anticipates improvements in injector technologies, including new preloaded disposable injectors; and new IOLs designed for smaller incisions.

All these enhancements will expand the premium IOL segment, which, by 2021, is expected to account for 10% of total IOL procedures and more than 25% of total IOL market revenues. The global IOL market is dominated by five companies: Alcon, Abbott Medical Optics, Bausch + Lomb, Carl Zeiss Meditec, and Hoya. These five are expected to generate more than 70% of global IOL revenues in 2016, according to Market Scope.

1. 2016 IOL Report: A Global Market Analysis for 2015 to 2021. Market Scope. https://market-scope.com/products-page/cataract-reports/2015-comprehensive-report-on-the-global-iol-market/. Accessed May 26, 2016.

Oasis Medical Receives CE Mark for Soft Shield Collagen Corneal Shields

Oasis Medical received the CE Mark for its Soft Shield collagen corneal shields, which allow ocular healing to occur by providing a protective barrier over the surface of the eye. As the shield gradually degrades, a thin layer of collagen is released, which helps lubricate the eye, according to a company news release.

Soft Shield collagen corneal shields are clear, pliable, thin films of highly purified bovine collagen that has been lightly crosslinked to provide the desired degradation time on the eye. The shields are hydrated dome-side-down and must be inverted before being placed on the eye. Once applied to the eye, the hydrated shield slowly absorbs ocular fluids that contain collagenases and proteases. These enzymes cause the shield to slowly lose shape and eventually degrade. The shield is thicker in the center and thinner toward the edge. When hydrated, the water content of the shield is 65% to 85%, depending on the degradation time.

There are four dissolution rates: QS, 12-, 24-, and 72-hour. The QS and 12-hour shields are used primarily after cataract surgery and are intended to dissolve completely on the eye under a patch within 1 day. The 24-and 72-hour shields are used primarily after ocular injections, corneal trauma, and nontraumatic corneal conditions. They are intended to be placed on a nonpatched eye and remain on the eye, similar to a contact lens, for the number of hours indicated. They will partially degrade during their time on the eye.  

Soft Shield collagen shields are supplied sterile by electron beam irradiation in a double peel tray. The inner tray is intended to be used to hydrate the shield, the news release said. 

Internationally Acclaimed Ophthalmologist and Former ESCRS President Peter Barry, FRCS, Dies

Peter Barry, FRCS, Head of the Department of Ophthalmology at St. Vincent’s University Hospital, Dublin, died May 26 after a short illness.

In a statement, the European Society of Cataract and Refractive Surgeons (ESCRS), said, “It is with very great sadness that the ESCRS announces the death of our beloved colleague and friend Dr. Peter Barry, who passed away on Thursday, 26 May 2016 after a short illness. The board, committees and members of the society extend their most heartfelt sympathy to his wife Carmel, and family David, Stephen, Simon, and Lisa … He was a person of great vision who made an immense contribution not only to the success of the ESCRS but to the wider world of ophthalmology.”

Dr. Barry was a founding member of the ESCRS and served as its president, treasurer, and director. He was a Senior Retinal Surgeon at the Royal Victoria Eye and Ear Hospital, Dublin. Dr. Barry completed his residency at Moorfield’s Eye Hospital in London, followed by a retina fellowship in the United States.

According to his practice biography, Dr. Barry achieved international acclaim as the organizer of a study on preventing postoperative infection after cataract surgery. The conclusion of this study resulted in the widespread use of intraocular antibiotics to prevent endophthalmitis and is considered one of the milestones in cataract surgery over the past 2 decades.

More recently, Dr. Barry presented results from the ESCRS Femtosecond Laser-Assisted Cataract Surgery (FLACS) study,1 showing that laser-assisted cataract surgery (LACS) is as good as routine phacoemulsification but does not currently outperform it. The study was the first to compare LACS and phacoemulsification in matched patients who were measured by major quality benchmarks, including visual acuity, surgically induced astigmatism, complications, and biometric errors.

Dr. Barry served on the ESCRS board for more than 20 years. He was a fellow of the Royal College of Surgeons in Ireland, the Irish College of Ophthalmologists, the American Academy of Ophthalmology (AAO), the American Society of Cataract and Refractive Surgery (ASCRS), and the United Kingdom and Ireland Society of Cataract and Refractive Surgeons (UKISCRS).

1.  Barry P. ESCRS/EUREQUO FLACS study. Data presented at: The European Society of Cataract and Refractive Surgeons annual meeting; September 14, 2014; London.

Imprimis Launches IV-Free Conscious Sedation, Compounded Triple Drop Formulations

Imprimis Pharmaceuticals announced plans to launch its IV Free MKO Melt conscious sedation formulations and new triple combination eye drop, which includes nepafenac, at the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting in New Orleans.

The patent-pending IV Free MKO Melt (midazolam, ketamine, and ondansetron) compounded conscious sedation formulation is an alternative option to intravenous (IV) anesthetic that is administered sublingually to sedate patients undergoing ocular and other surgical procedures, a company news release said. The MKO Melt, in troche format, provides consistent and predictable dosing and allows quick and easy administration, resulting in increased positive experiences for patients and staff, according to the company. The formulations or variations have been used in more than 1,000 LASIK and cataract surgeries to date.

“With IV sedation, it seemed that the patients were entering the [operating room] anxious, and once that anxiety cycle began it was hard to reverse or break,” William F. Wiley, MD, Medical Director of Cleveland Eye Clinic and codeveloper of the MKO Melt, said in the news release. “With sublingual sedation, onset begins in the preop area, and, by the time the patient is being wheeled back to the [operating room], the patient is feeling good.”

According to Imprimis, the patent-pending conscious sedation custom formulation has broad applications, and the company plans to pursue other significant large therapeutic markets that may benefit from MKO Melt compounded medications, including vasectomy procedures, colonoscopies, oral dental surgeries, and other outpatient surgical procedures in which traditional IV sedation methods are used.

Imprimis also introduced its Pred-Moxi-Nepafenac (prednisolone acetate, moxifloxacin HCl, and nepafenac) combination topical eye drop formulation. The company now offers four proprietary antibiotic, steroid, and nonsteroidal combination LessDrops topical formulations: Pred-Moxi, Pred-Ketor, Pred-Moxi-Ketor, and the new PredMoxi-Nepafenac for use after cataract, LASIK, PRK, and other ocular surgeries.

TearScience Introduces LipiScan for Rapid High-Definition Meibomian Imaging

TearScience released the LipiScan, a high-definition gland imaging device that allows eye care professionals to assess meibomian gland structure during routine workups in a practice setting, at the ASCRS annual meeting.

The LipiScan device harnesses patented dynamic meibomian imaging (DMI) technology to produce high-definition images of meibomian glands, according to a company news release.

“The LipiScan is a technology to help doctors and practices scan meibomian glands. It’s a smaller, more portable, and affordable device that makes screening of the meibomian glands much easier in the practice,” Joseph Boorady, OD, President and CEO of TearScience, said in an interview with Eyewiretoday.com. “Eighty-six percent of all dry eye patients have involvement of meibomian gland dysfunction, and that is why we are so passionate about that condition. The best treatment for meibomian gland dysfunction is LipiFlow. So this new LipiScan will allow the diagnosis of meibomian gland dysfunction to be obtained easier, and allow doctors to recommend the Lipiflow treatment much faster.”

Surgilum Introduces First Self-Illuminating Photon Speculum

Surgilum introduced the Photon Speculum, the first self-illuminating eye speculum, at the ASCRS annual meeting. The product is made up of a single-use corneal transilluminator that magnetically attaches to the Surgilum Speculum. Its tangential light illuminates the anterior segment with the power of a slit lamp, enabling surgeons to see greater detail, according to a company news release.

Surgeons can independently control the tangential light on both arms of the Photon Illuminator. The Photon Speculum reduces glare compared with using a microscope light during ophthalmic surgery, and its tangential light avoids the risk of retinal phototoxicity, the news release said.

Surgilum also announced that a new formula is available for its RoboMarker, a self-leveling corneal marker used in toric IOL, limbal relaxing incision, LASIK, and femtosecond laser surgeries. The formula makes RoboMarker’s marking visible in infrared light during femtosecond laser surgery, the news release said.  

RoboMarker’s gravity-based system has been tested and shown to hold a chosen axis to within 1° of accuracy, allowing the surgeon to focus on marking rather than on keeping the marking device level. RoboMarker makes corneal marking faster, with well-defined marks that last up to 2 hours. Its pre-inked marking tips are sterile and disposable.

RoboMarker, which saves an estimated 5 to 8 minutes per surgical case, works by rotating its indicator dial to the desired axis. Its gravity-based, self-leveling system keeps the RoboTip in place, regardless of how the surgeon holds the device.

Meta-Analysis Shows Safety, Efficacy of Multifocal IOL Implantation After Cataract and Refractive Lens Exchange

A meta-analysis supports the safety and efficacy of multifocal IOL implantation following cataract surgery and refractive lens exchange, according to study in the Journal of Cataract and Refractive Surgery.1

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The investigators examined data from 195 published studies of a variety of multifocal IOLs including more than 8,700 eyes. This review was initiated to better understand the strengths and weaknesses of multifocal IOLs, according to a news release from the American-European Congress of Ophthalmic Surgery (AECOS).

A subset of 5,359 patients had both eyes treated with multifocal IOLs; 99.9% of these patients achieved vision sufficient to see 20/40 at distance without glasses, the news release said. This is the level of vision typically required to obtain an unrestricted driver’s license in the European Union and the United States. Near vision sufficient to perform reading and other tasks was measured in all studies, with high levels of spectacle freedom reported in most patients.

“This comprehensive review confirmed our own clinical data showing that multifocal IOLs provide excellent freedom from spectacles for distance and near vision, while maintaining very high levels of patient satisfaction,” study author and AECOS European executive committee member Jorge L. Alió, MD, PhD, said in the news release.

“This meta-analysis review is perhaps the largest of its kind on the topic of multifocal IOLs,” study author and AECOS chairman of the board Steven J. Dell, MD, said in the news release. “The results of this review demonstrate the safety and efficacy of multifocal IOLs, and we conclude that multifocal IOLs are an appropriate choice for properly selected patients.”

1. Rosen E, Alio JL, Dick HB, Dell S, Slade S. Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: Metaanalysis of peer-reviewed publications. J Cataract Refract Surg. 2016;42(2):310-328.

Bausch + Lomb, IBM Collaborate on App for Cataract Surgeons

Bausch + Lomb and IBM will collaborate to develop an iPhone and iPad app for cataract surgeons, according to a news release. The app is intended to help surgeons streamline their workflow by delivering patient information and clinical insights as well as IOL options on a single digital platform at the point of care.

The app will be designed to provide surgeons with access to information that patients have agreed to share, enabling doctors to plan surgical interventions—including IOL selection—and have the option to view the information on digital devices or display screens in the operating room during surgery. The app will be designed to electronically manage patient data across iPhone and iPad devices while hosting health-related data on the IBM Cloud Platform, BlueMix, and relaying customized IOL options to surgeons.

The MobileFirst for iOS team, which is part of IBM Global Business Services, will design and develop this custom app for Bausch + Lomb. The company’s vision is to optimize the app to collect data over time, resulting in a cognitive app that applies machine-based learning and predictive analytics to deliver real-time insights to surgeons, the news release said.

By compiling each cataract patient’s information in the app—including IOL calculations, corneal topography, and other biometry results as well as lifestyle preferences—surgeons and staff may generate a comprehensive, integrated profile to help facilitate IOL selection and procedure planning. Historical surgical data and other patient insights can also be housed within the app to potentially support positive clinical outcomes for future cataract.

“This new mobile solution has real potential to fundamentally change how our practice manages patient information throughout the cataract procedure, from planning through postoperative follow-up,” Anil Shivaram, MD, of Claremont Eye Associates in California, said in the news release. “Additionally, having the ability to access the variety of each patient’s surgical information on an iPhone or iPad will allow surgeons to streamline their time management and decision-making process.”

Pilot study testing for the new application is expected to begin in late 2016. n

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



WHO: Life Expectancy Worldwide has Risen by 5 Years
According to a report from the World Health Organization, the overall global life expectancy has increased by 5 years to just over 71 years, reversing a decline seen in the 1990s.

Zika Virus May Reach Europe This Summer
Countries with a moderate risk from the Zika virus include France, Spain, Italy, and Greece, while the risk in the United Kingdom is low, according to the World Health Organization.

Father’s Age, Lifestyle Associated With Birth Defects
A growing body of research reveals associations between birth defects and a father’s age, alcohol use, and environmental factors, researchers say.

Exercise Cuts the Risk for 13 Cancers
Higher levels of leisure-time physical activity were associated with a significantly lower risk of developing a number of cancers, the results of a pooled analysis of data from more than 1 million Europeans and Americans reveal.

Elderly Benefit From Intensive BP Treatment
Intensive treatment of high blood pressure (BP) reduces older adults’ risk of heart disease without increasing their risk of falls or other complications, a study shows.