EyeWorld Asia-Pacific December 2012 Issue

29 EWAP CATARACT/IOL December 2012 doctor. Although there are other high-end instruments that can transform their readings into the same type of map that is offered by the CATRA, they are expensive. “They cost a lot of money,” Mr. Pamplona said. “It would be [US]$25,000 or [US]$50,000 in the U.S., so they’re not good for the developing world.” He pointed out that as a result, these don’t help to solve the problem of avoidable blindness in developing countries. “Ours is much cheaper,” he said. “We assume that everyone has a cell phone; the plastic piece that goes on top of this to make it work will cost only $3 or $4.” On top of that, this will involve downloading an app, something that Mr. Pamplona anticipates will cost at most US$0.99. He pointed out that currently there is nothing readily offering this information on maps. It also offers other advantages. “There’s the alternative of checking the progression of the cataract over time because the end users can do this at home, and they can see if it’s growing or not—if it’s becoming more dense or not,” Mr. Pamplona said. In particular, this technology lends itself to undeveloped countries where they don’t have ready access to ophthalmologists. “[There are] people in the big cities buying this device and going to villages to screen people,” Mr. Pamplona said. “Then they go back to the city and file the data into some hospital, and the hospital decides to bring that person to the city to have the surgery done.” This can all be done without having to invest a lot of money, he pointed out. surgeons have all used one through a limbal incision, but that may not be the best approach in many cases; it may be better to go through the pars plana, and I think most cataract surgeons still don’t do this,” he said. Using the PAL technique, the surgeon would go in with some viscoelastic and very small 25-gauge vitrectors and remove the anterior vitreous through the pars plana, Dr. Packer said. “To me this is a superior technique because you’re pulling vitreous posteriorly instead of anteriorly so you have less likelihood of getting vitreous in the incision and these endless vitrectomies that end up with a very soft eye,” he said. Dr. Mieler said that there have been some attempts to try to irrigate the particles forward, which generally speaking is not very successful and certainly can induce additional retinal complications. “When a patient experiences loss of part of the nuclei, in most cases, it’s going to require vitrectomy surgery to remove the fragments and clean things up because a lot of inflammation can be excited by the condition,” he said. While there are times an anterior segment surgeon can manage a posterior capsular rupture, caution has to be exercised regarding where the nucleus particles are and how far back, he added. For Dr. Packer, his cut-off point is whether or not he can see the material and how fast it’s falling. “If I can’t see it, I’m not going after it,” he said. EWAP Editors’ note: The doctors mentioned have no financial interests related to this article. Contact information Agarwal : +91 44 2811 6233, dragarwal@vsnl.com Mieler : +312 996 7832, wmieler@uic.edu Packe r: 541-687-2110, mpacker@finemd.com Dialing - from page 27 Tel: +65 64936953 Fax: +65 64936955 Patients could download the app and if they detected a problem, they could visit a practitioner for treatment, he believes. In the hands of doctors, it could offer more quantitative data. However, this must wind itself through the U.S. FDA, which Mr. Pamplona anticipates will likely take 1 or 2 years. In the end, the workability comes down to the idea that the cell phone has the electronic goods to deliver a reliable diagnosis. “The center for the Hartmann works in the resolution of 10 micrometers, and the cell phone screen has a resolution of 30 micrometers,” Mr. Pamplona said. “So you will have in your pocket a device that has only one-third the resolution of a high-end device.” Going forward, it is important to start thinking about what else this can be used for, he said. “We have a bunch of other projects in line that can measure, for instance, macular degeneration, dry eyes, and amblyopia—a lot of different diseases that can start giving people a number,” Mr. Pamplona said. “Doctors need to say what this number is, and if it goes beyond that, [patients] need to search for an optometrist or an ophthalmologist.” EWAP Editors’ note: Mr. Pamplona has no financial interests related to this article. Contact information Pamplona: vitorpamplona@gmail.com