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Tecnis Multifocal IOL Providing excellent range of vision at all distances post-cataract surgery (Eyeworld April 2010).

A recent study of three presbyopic IOLs showed that the Tecnis Multifocal IOL (Abbott Medical Optics Inc., Santa Ana, Calif.) provides outstanding performance at all distances and superior performance at intermediate and near. Guy Kezirian, M.D., and Elizabeth Davis, M.D., conducted the study that compared the visual outcomes at distance, intermediate, and near for the Tecnis MF IOL, Crystalens HD (Bausch & Lomb Surgical, Aliso Viejo, Calif.), and ReStor +3 (Alcon, Fort Worth, Texas).  The analysis of 3,177 eyes (2,641 eyes/Crystalens HD, 391/ReStor +3 D, and 145/Tecnis MF) used data collected through DataLink Inc., a repository of IOL data reported by surgeons worldwide.  Ninety-one percent of the Tecnis patients saw 20/30 or better, compared with 90% of the Crystalens HD patients and 86% of the ReStor +3 patients for UCVA at distance.  For intermediate vision, 87% of Tecnis patients saw 20/30 or better, compared with 84% of Crystalens HD patients and 68% of ReStor +3 patients.  Ninety-nine percent of Tecnis patients achieved 20/30 at near, compared with 91% of ReStor patients and 65% of Crystalens patients.  "The Tecnis MF provided excellent vision at all distances and superior performance at intermediate and near.  The Tecnis MF and Crystalens HD provided similar excellent intermediate vision that was superior to that of the Restor +3," said Davis.

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Roundup of Femtosecond Lasers for Cataract Surgery.

4/26/10 Representatives from the three companies currently developing femtosecond laser cataract surgery technology--LenSx Lasers, Inc.  (Aliso Viejo, CA), LensAR, Inc. (Winter Park, FL), and Optimedica Corporation (Santa Clara, CA)--spent much of the ASCRS discussing the future of this breakthrough technology.

LenSx

Stephen G. Slade, MD, who performed the first femtosecond laser cataract surgery in the United States in February, shared his experience using the laser made by LenSx Laser Inc.1

Dr. Slade said all the patients he operated on saw 20/25 or better the first day after surgery and all of the capsulotomies were perfectly centered and achieved a diametric accuracy of ±0.25 mm.

"We now have something that we can standardize and work from.  We know exactly the capsulorhexis size...  With this technology, we're able to have a much faster phaco time and we're able to [use] less [ultrasound] power.  I do believe it will make [the procedure] much safer," Dr. Slade said.

"This is going to be of great benefit to the public's health.  [Femtosecond laser cataract surgery] is going to increase reproducibility of outcome in an operation that is done 20 million times a year in the world, and significantly lower the complication rate and make the less-skilled surgeon perform at a higher level," said Dick Lindstrom, MD, at a LenSx-sponsored symposium.

The LenSx Laser is currently the only femtosecond laser to receive 510(k) clearance by the FDA for the creation of anterior capsulotomies and corneal incision.

  1. Slade S. LenSx Laser Technology Introduction.  Paper presented at the: LenSx Laser Breakfast Symposium; American Society of Cataract and Refractive Surgery Annual Meeting; April 9, 2010; Boston.
LensAR

During a booth presentation, Randy Frey, chief executive officer of LensAR, Inc., gave a brief history of the company and outlined his future plans for the LensAR Laser System.

Mr. Frey said the company's original priority when it was formed in 2004 was the treatment of presbyopia by using a laser to soften the natural crystalline lens to restore accomodation.  After system software upgrades and successful animal trials in 2006 and 2007, the company decided to shift its focus to cataract surgery.  Mr. Frey said in human trials in Mexico, the laser cleanly cut higher-grade cataracts up to grade 4.

"We had made some specific design decisions hoping to achieve effectiveness in higher cataract grades, but we were amazed how efficiently it worked for our earliest patients," Mr. Frey said.

LensAR is close to receiving anterior capsulotomy approval and has good clinical data on nuclear lens fragmentation, Mr. Frey said.  The system is being designed to deliver capsulotomies, lens fragmentation, limbal relaxing and corneal incisions.  LensAR would need individual 510(k)'s for each indicated use.

"We would look to be selling lasers as soon as we have at least one approval, but from a practical standpoint, it's probably best to have fragmentation and capsulotomy together.  And it would be shortly after that we will be offering software upgrades," Mr. Frey said.

The design of the LensAR system is almost complete and the company plans to have a laser on the floor at the October AAO meeting in Chicago, Mr. Frey said.

OptiMedica

In an interview with Cataract & Refractive Surgery Today, Mark J. Forchette, president and chief executive officer of OptiMedica Corp., called femtosecond lasers for cataract surgery "breakthrough technology" and one of the most promising therapeutic areas in ophthalmology.

Unlike other manufacturers in the cataract femtosecond laser market, OptiMedica, which developed its reputation in the field of retinal surgery and retinal lasers with the Pascal Photocoagulator, has not released details concerning specific capabilities of the cataract laser device, nor has it published any results from its trials conducted in the Dominican Republic.

Company literature reports that the laser is capable of creating precise corneal incisions and capsulorhexis and of fragmenting the lens.  OptiMedica's breakthrough pattern scanning technology, an ultra-fast laser and integrated optical coherence tomography imaging, is designed to dramatically improve the complex cataract procedure by replacing its most technically demanding and manual steps, according to a company news release.

Mr. Forchette said he was pleased with the results of its feasibility study and the company is now in the process of conducting a study for an FDA filing.  OptiMedica also announced during the ASCRS conference that its medical advisory board is comprised of 12 ophthalmologists, eight of whom have used the company's cataract system in the clinic.

"Is being first the most important thing? I think it's really about precision.  If you can be first and the most precise, that's great, but I'm going to weigh precision as being the more critical factor, being able to deliver precise performance because that's what this is all about," Mr. Forchette said.  "There's lots of examples of companies that weren't first that wound up winning the market, and I think that boils down to performance.

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Accommodating IOL Offers Zero Aspericity

4/8/2010 Patients report an increase in near vision over the first year after Crystalens (Bausch + Lomb, Rochester, NY) implantation, according to a presentation made at Bausch + Lomb's media event.1

In a study of 91 eyes implanted with the Crystalens AO, 87% were within 0.50 D of intended correction, with no significant shift in correction between 1 and 3 months.  The majority of patients at 3 months had at least 20/30 UCVA for distance, intermediate, and near, said John A. Hovanesian, MD, a clinical instructor at UCLA Jules Stein.  A slight drop-off in near vision occurred but improved over the postoperative first year.

According to Dr. Hovanesian, the Crystalens AO provides similar results to the HD; the major difference between these models is the enhanced contrast sensitivity of the AO, due to its uniform, zero-asphericity power from the center to the edge of the optic.  The Crystalens AO provides "the highest depth of field with minimal reduction of quality of vision," Dr. Hovanesian said.  "Quality of vision is preserved across the broadest range with the AO series of lenses because the eye's total spherical aberration ends up about +0.27 µm."

Early data show that, with the Crystalens AO, approximately 80% of patients achieve 1.50 D of accommodation or greater and 24% achieve more than 2.00 D at 1 month.  Dr. Hovanesian suggests that surgeons target the first eye at plano to -0.25 D and the second eye at -0.25 to -0.50 D. "Clearly that is not monovision, but that slight difference allows a very functional range of vision at distance, intermediate, and near."

Dr. Hovanesian is a consultant to Bausch + Lomb.

Hovanesian J. Benefits of the Crystalens AO lens including latest US data.  Paper presented at the: Bausch + Lomb Surgical Media Event; American Society of Cataract and Refractive Surgery Annual Meeting; April 8, 2010; Boston.