Game Changers in Ophthalmology: 2011
Game Changers in Ophthalmology: 2011
Hello. I am Roger Steinert, Professor and Chair of Ophthalmology at the Gavin Herbert Eye Institute, University of California, Irvine. Today I would like to talk about some game changers in ophthalmology: things that are going to change how we treat patients in the very near future.
Game Changers in Cornea
The first of these is related to the cornea. Collagen cross-linking has received a lot of talk -- and deservedly so. This technique has been used for decades with consistently positive results in Europe. Studies are still under way trying to develop ways of avoiding removal of the epithelium, speeding up the total procedure time through different formulations of the riboflavin dye that is applied to the cornea, and increasing the dose of ultraviolet light that results in the chemical changes through the photochemistry with the riboflavin. This is all very exciting, particularly because the Avedro Company (Waltham, Massachusetts) has received a compassionate-use exemption from the US Food and Drug Administration (FDA), so the trials on collagen cross-linking for keratoconus and post-LASIK ectasia can finally begin once again in the United States. Another advance may be the ability to use heating techniques on the cornea to reshape it, whether it's for keratoconus or for a refractive error. Unlike in the past, when thermal effects on the cornea were always short lived, the hope is that the collagen cross-linking will lock in the effect. So far, that has been shown to work in trials in Europe with the Avedro device. That will be the next phase of that trial here in the United States.
Game Changers in Glaucoma
The field of glaucoma is seeing a lot of activity now. The Glaukos Corporation (Laguna Hills, California) is getting full final FDA premarket approval for its stent, and it will be on the market very soon. A number of other trials are under way with other companies looking at various stents and shunts all directed at achieving long-lasting improvement in intraocular pressure reduction, diverting the aqueous into the ciliary space as well as into the subconjunctival space or into the trabecular meshwork. This will be a very interesting and dynamic field for the near future. Along with that are very ingenious ways of trying to measure intraocular pressure on an ongoing basis so that we can finally get a reasonable handle on both compliance and circadian rhythm variations in pressure, thereby obtaining better pressure control. We are also looking at time-release glaucoma medications so that we are not dependent on patient compliance with the use of drops.
Game Changers in Retinal Disease
In addition, in terms of time-release agents, is the ongoing work in the retinal world with anti-inflammatory medication and especially VEGF Traps for treating retinal disease. The need for repeated injections has been a major drawback to the current treatment of macular degeneration. A number of companies are working on a time-release injectable that will avoid the need for repeated injections. Work is ongoing for new formulations of VEGF Traps that will be more effective and more long lasting. Hopefully, the periodic 4- to 6-week injections will soon be a thing of the past, much to the relief of both doctors and patients. Also exciting is the realization that VEGF Traps seems to work very well in other situations. We are starting to see some positive results with the treatment of other problems such as diabetic macular edema, postoperative cystoid macular edema, and vein occlusions, so a number of other pathologies seem to benefit from these genetically engineered drugs that are directly targeting some of the pathology in the retina.
Game Changers in Cataract Surgery
Something timely in the sphere of cataract surgery, of course, is the controversy and excitement on femtosecond laser refractive cataract surgery. Loads of publicity has surrounded this technology, but what we are seeing, bottom line, is a fairly rapid introduction of the technology into both the US market and the worldwide market as other companies start to obtain approval. LenSx (Alcon; Fort Worth, Texas) was the first, and now OptiMedica Corporation (Santa Clara, California) is getting the CE [European Community] mark, and Bausch & Lomb's (Rochester, New York) Technolas™ is announcing that they will soon be able to openly market their device in Europe as well. We are eagerly awaiting more information about how the market reacts to this and how people will integrate these expensive, but also very exciting devices, into their practices.
A major debate over the cost has focused on when this will become more mainstream, and how that might affect the price as well. At the recent American Academy of Ophthalmology meeting, there was talk about the so-called "inflection point" on a new technology like this, and that when this technology will really start to become a major player in the cataract market could be as short as 3 years. This would be the most rapid acceptance of a major new technology in the history of ophthalmology.
These are the real game changers in ophthalmology for the future. My name is Roger Steinert. Please drop me a note if you have any questions or thoughts. Thank you very much.
Hello. I am Roger Steinert, Professor and Chair of Ophthalmology at the Gavin Herbert Eye Institute, University of California, Irvine. Today I would like to talk about some game changers in ophthalmology: things that are going to change how we treat patients in the very near future.
Game Changers in Cornea
The first of these is related to the cornea. Collagen cross-linking has received a lot of talk -- and deservedly so. This technique has been used for decades with consistently positive results in Europe. Studies are still under way trying to develop ways of avoiding removal of the epithelium, speeding up the total procedure time through different formulations of the riboflavin dye that is applied to the cornea, and increasing the dose of ultraviolet light that results in the chemical changes through the photochemistry with the riboflavin. This is all very exciting, particularly because the Avedro Company (Waltham, Massachusetts) has received a compassionate-use exemption from the US Food and Drug Administration (FDA), so the trials on collagen cross-linking for keratoconus and post-LASIK ectasia can finally begin once again in the United States. Another advance may be the ability to use heating techniques on the cornea to reshape it, whether it's for keratoconus or for a refractive error. Unlike in the past, when thermal effects on the cornea were always short lived, the hope is that the collagen cross-linking will lock in the effect. So far, that has been shown to work in trials in Europe with the Avedro device. That will be the next phase of that trial here in the United States.
Game Changers in Glaucoma
The field of glaucoma is seeing a lot of activity now. The Glaukos Corporation (Laguna Hills, California) is getting full final FDA premarket approval for its stent, and it will be on the market very soon. A number of other trials are under way with other companies looking at various stents and shunts all directed at achieving long-lasting improvement in intraocular pressure reduction, diverting the aqueous into the ciliary space as well as into the subconjunctival space or into the trabecular meshwork. This will be a very interesting and dynamic field for the near future. Along with that are very ingenious ways of trying to measure intraocular pressure on an ongoing basis so that we can finally get a reasonable handle on both compliance and circadian rhythm variations in pressure, thereby obtaining better pressure control. We are also looking at time-release glaucoma medications so that we are not dependent on patient compliance with the use of drops.
Game Changers in Retinal Disease
In addition, in terms of time-release agents, is the ongoing work in the retinal world with anti-inflammatory medication and especially VEGF Traps for treating retinal disease. The need for repeated injections has been a major drawback to the current treatment of macular degeneration. A number of companies are working on a time-release injectable that will avoid the need for repeated injections. Work is ongoing for new formulations of VEGF Traps that will be more effective and more long lasting. Hopefully, the periodic 4- to 6-week injections will soon be a thing of the past, much to the relief of both doctors and patients. Also exciting is the realization that VEGF Traps seems to work very well in other situations. We are starting to see some positive results with the treatment of other problems such as diabetic macular edema, postoperative cystoid macular edema, and vein occlusions, so a number of other pathologies seem to benefit from these genetically engineered drugs that are directly targeting some of the pathology in the retina.
Game Changers in Cataract Surgery
Something timely in the sphere of cataract surgery, of course, is the controversy and excitement on femtosecond laser refractive cataract surgery. Loads of publicity has surrounded this technology, but what we are seeing, bottom line, is a fairly rapid introduction of the technology into both the US market and the worldwide market as other companies start to obtain approval. LenSx (Alcon; Fort Worth, Texas) was the first, and now OptiMedica Corporation (Santa Clara, California) is getting the CE [European Community] mark, and Bausch & Lomb's (Rochester, New York) Technolas™ is announcing that they will soon be able to openly market their device in Europe as well. We are eagerly awaiting more information about how the market reacts to this and how people will integrate these expensive, but also very exciting devices, into their practices.
A major debate over the cost has focused on when this will become more mainstream, and how that might affect the price as well. At the recent American Academy of Ophthalmology meeting, there was talk about the so-called "inflection point" on a new technology like this, and that when this technology will really start to become a major player in the cataract market could be as short as 3 years. This would be the most rapid acceptance of a major new technology in the history of ophthalmology.
These are the real game changers in ophthalmology for the future. My name is Roger Steinert. Please drop me a note if you have any questions or thoughts. Thank you very much.
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