EyeWorld Korea September 2019 Issue

Cutting Edge Technology in Cataract Surgery T he Alcon (Japan) Morning Symposium began with Rosa Braga-Mele, MD , FRCSC, introducing the PanOptix IOL, a new trifocal IOL, designed for more natural adaptability for the patient with more optimized light utilization, more comfort with near to intermediate range of vision, and less dependency on pupil size. PanOptix transmits 88% of light at 3-mm pupil size to the retina, resulting in higher quality of vision and better contrast sensi- tivity. In studies, PanOptix IOL outperforms the Tecnis Symfony significantly in terms of binocular distance corrected visual acuity (LogMAR) at near distance (40 cm or 16 in). With her first 10 patients, Dr. Braga-Mele was able to achieve 20/20 distance in both eyes, J1 near after the first eye, J3 to J2 intermediate at 55 to 60 cm, and minimal halo and glare complaints. Another new IOL is the Clareon IOL which is manufactured from hydrophobic acrylic material with a refractive index of 1.55 and a water content of 1.5%. In Pursuit of Innovation in Cataract Refractive Surgery T he Clareon AutonoME delivery system is an automated, dispos- able, preloaded delivery device designed to enable easy, intuitive control of IOL delivery, said Michael Lawless, MBBS, FRANZCO, FRACS , during an Alcon-sponsored lunch symposium. The Clare- on lens itself is designed to resist phase separation, and boasts the lowest level of surface haze, subsurface nanoglistening, and glistenings of any monofocal IOL. “It has a ‘softer’ feel to it than the SN60WF,” he said. In a meta-analysis of Nd:YAG capsulotomy rates, at 1 year, the Clareon performed better than the AcrySof, with only 0.62% needing YAG (compared to AcrySof’s 1.44%). The AutonoME delivery device has four strong pillars: it’s easy to use with single-handed control; it’s intuitive for ergonomics and hand placement; it offers good control to offer precise delivery into the capsular bag and pro- tects wound through property depth guard and 3mm nozzle; and it allows for counter pressure with instrument in side-port incision. Thomas Kohnen, MD, PhD, FEBO , said the EDOF lenses have better contrast sensitivity than trifocal lenses. Overall, distance vision is comparable, but the near and intermediate vision is better with the PanOptix lens. (Of interest, the PanOptix is the first trifocal lens introduced in the U.S.). The “ideal patient” for trifocal IOLs includes a generally healthy eye, with no corneal pathology, no severe corneal irregularities, and no macular pathol- ogy. Surgeons can help these patients achieve the best visual outcomes by improving the corneal surface. Aside from corneal disease, Dr. Kohnen said contraindications for trifocal IOLs are glaucoma and retina disease. The toric PanOptix outcomes are comparable to the non-toric lenses, he added. Abhay Vasavada, MS, FRCS , called the Centurion “the most advanced phaco system yet.” The “Active Sentry” handpiece signals to the Centurion system hardware and software that adjustments are needed to maintain the target IOP, eliminating the need for manual adjustments. Further, studies show there is better mitigation of occlusion break surge with Active Sentry than without, and the absolute IOP and percentage reduction of IOP is lower with Active Sentry compared to Active Fluidics without Active Sentry. Finally, Daniel Gatinel, MD, PhD , spoke about “Custom-Q for hyperopia and presbyopia,” a corneal-based refractive multifocality. Two preliminary questions need to be asked: which change in negative spherical aberration (SA) can be achieved, and which change in Q is necessary to achieve the SA change? The variation of the curvature from the paraxial area to the pe- riphery is Q > -0.5 and SA, and a variation of the refractive power from the paraxial to the periphery is Q < -0.5 minus the SA. Kaizen in My Cataract Surgeries N ew technologies in cataract surgery mean increased ease in performing procedures. In this morning’s Alcon Surgical Video Symposium, Shunsuke Osawa, MD , outlined his experience with the NGenuity 3D Visualization System noting three signif- icant impacts it has made on his surgeries: microscope, ma- chine, and 3D visualization. With microscopes, “resolution and depth of field have a trade-off relation- ship” when it comes to current technologies. However, NGenuity solves the issue and has a deep depth of field while maintaining high resolution. In the 3D video that Dr. Osawa presented, the anterior capsule was incredibly clear. Two features of the Centurion machine that Dr. Osawa used stand out: its ability to maintain a stable anterior chamber and a balanced tip during proce- dures, which was clearly shown in the videos. Regarding visualization, “NGenuity has opened the door to” digitally assisted ophthalmic surgery and its impact on 3D visualization is very good, said Dr. Osawa. Guangbin Zhang, MD , made a similar comment stating that “using NGenuity allows me to not only see straight, but I can see better throughout the surgery.” Dr. Zhang highlighted that NGeunuity has allowed improvements in his prac- tice with ergonomics, collaboration, and teaching. “It helps me with my neck and back pain,” he said. It also helps with collaboration as from a video of Dr. Zhang’s operating room, an assistant can be seen preparing the next instru- ment he needs to use. Finally, teaching and demonstrating with 3D video is better for residents and fellows to fully understand procedures. When asked how long it takes to become accustomed to NGenuity, Dr. Zhang said, “for experienced surgeons, the learning curve may be only 5 to 10 cas- es. For Dr. Osawa, it could be about 1 month for most surgeons. Alcon’s Active Sentry Handpiece was also discussed as an evolutionary fluidic tool in phacoemulsification. The handpiece itself has a built-in pressure sensor and allows for real-time measurements of intraocular pressure (IOP). There is a constant feedback mechanism that Active Sentry utilizes, offering better IOP control. Patient eye level is also automatically predetermined. Of this new technology, Prin Rojanapongpun, MD , said, “It makes good use of active fluidics system. It makes sense to have this advantage.” Dandapa- ni Ramamurthy, MD also commented on how it provides a more peaceful surgery experience. With the new technologies presented in today’s Alcon Symposium, “I think our surgeries can reach a high level of outcome and precision,” said Dr. Rojanapongpun. Alcon Educational Symposia at APACRS 2019 The Clareon IOL also acts as a UV blocker and its design is based on the plat- form of its predecessor, the single-piece AcrySof lens. In three different stud- ies, Liliana Werner, MD, PhD , outlined how the Clareon IOL has been shown to produce lower pixel haze intensity, lower and negligible axial displacement (10 mm compression) and corresponding dioptric power, and, when compared to AcrySof lens, no difference in postoperative inflammation and capsular bag opacification. Finally, David Lubeck, MD discussed the Active Sentry Handpiece (Alcon) and its ability to decrease the risk of posterior capsular rent (PCR), resulting in decreased physical costs by a reduction in the risk of surgical complica- tions. In turn, ophthalmologists can see decreases in procedure time, inflam- mation, risk of endophthalmitis, and risk of retinal detachment. Dr. Lubeck described how PCR occurs typically when instruments come into contact with the capsule during phacoemulsification, which happens more than 60% of the time. With Active Sentry, the IOP sensor is built into the phaco handpiece and directly measures intraoperative IOP and communicates with the Centu- rion Active Fluidics to actuate immediate adjustments. This new technology results in better surge mitigation, more stable target IOP, and compensates for leakage.