The exhibit hall at the annual meeting of the American Society of Cataract and Refractive Surgeons, held in Boston this year, included a preview of laser cataract surgery, multitasking microscope attachments, an intraocular lens promoted as the world's most accurate and many other innovations that could assist your ophthalmic surgeons.

Here's a review of some of the highlights.

Laser cataract surgery
Will precision lasers revolutionize the practice of cataract surgery? Three companies at the show generated a considerable amount of buzz with their vision of a future in which femtosecond lasers reduce or even eliminate the need for blades and ultrasonic handpieces. While none of the companies — LensAR, LenSx Lasers and OptiMedica — showcased a product, each is awaiting FDA approval to market the technology in the United States for use in multiple stages of refractive surgery. A LenSx representative says the company is planning an official launch at the American Academy of Ophthalmologists' annual meeting this October in Chicago, LensAR says it has its sights set on early next year and OptiMedica is currently in clinical trials.

It's an exciting development, and I'm curious to see if this technology can deliver improved patient outcomes. A femtosecond is one-millionth of a nanosecond, which is itself a billionth of a second. The manufacturers say this ultra-short laser pulse, coupled with ocular measurement and scanning technologies, can automatically replicate several manual steps in the cataract surgery process, including incision, limbal relaxing incision and capsulorhexis to precise size and orientation as well as lens fragmentation and lens softening.

Of course, these devices can only carry out part of the procedure. Some phacoemulsification may have to be done by hand, depending on the hardness of the cataract, as will all of the irrigation/aspiration work. Plus, when you think about it, we can do cataracts manually in 5 minutes, so what gains do these offer? Still, lasers seem to promise consistent results far beyond the reach of even the most skilled hands.

Microscopes and attachments
Carl Zeiss Meditec's new OPMI Lumera 700 Microscope features the company's proprietary Stereo Coaxial Illumination, which uses 2 beams of light aligned with the oculars (and your eyes) to reflect back a red reflex that uses the scope's stereoscopic view to great advantage. It also has a high-def video recording system that's integrated into the scope, so archiving cases no longer means a scope cluttered with external cables. Built on a modular basis to customers' specifications, the OPMI Lumera 700 starts in the low $100,000s.

Even more impressive, though, is what you can add on to your Zeiss scope. If your physicians perform vitreoretinal cases or if your facility is considering hosting retinal surgery, the Resight Fundus Viewing System can save you a lot of time and inefficiency. Until now, bulky retinal viewing attachments added on below a scope's objective lens tended to adversely affect your working distance, but Zeiss's compact Resight only adds an inch to the stack height. Considering that retinal procedures may require you to switch between posterior and anterior views multiple times, its ability to easily slide in and out of position and automatically focus the scope provides big advantages over having to manually change lenses and refocus each time. Plus, its 127-degree, wide-angle field of view offers edge-to-edge focus. The Resight attachment, which can be fitted to Lumera models of the past decade, lists at $24,285 for the basic model and $25,920 for the motorized model.

Surgical imaging device manufacturer Med X Change introduced its HDMD All-In-One (AIO) high-def digital display and recording system (starting at $17,000). Distributed exclusively through Leica Microsystems and compatible with its M800 series of scopes, the system looks like a 19-inch, flat-panel, medical-grade monitor that can be mounted on a scope, pole, boom or workstation table. But integrated into that compact package are a high-resolution photo and video recorder, a 320GB hard drive that can hold 50 hours of HD video, a CD/DVD burner and 2 USB ports. Surgical documentation is a niche market for most physicians and facilities, but if you do record procedures for education or presentation, the fact that your nurses and techs won't have to drag a whole cart of extra equipment to the OR is a breakthrough.

IOLs, improved
I was astonished to learn that the standards governing the manufacture of intraocular lenses allow a variance of plus or minus 0.4 diopters in power from the labeled prescription. That's a pretty wide range. What that means is, the surgeon attempting to deliver uncorrected vision might, through no fault of his own, end up way off target and not know it until he's testing a dissatisfied patient. With its Softec HD IOL, however, LensTec is pioneering an FDA-inspected, precision manufacturing process that's designed to create the world's most accurate bi-aspheric IOL. With a variance of plus or minus only 0.125D, and available in 0.25D rather than conventional 0.5D increments, Softec IOLs should enable increased accuracy and more predictable results in lens implantation. Softec lists at $150 to $200.

Hoya Surgical Optics has been manufacturing precision lenses for nearly 70 years. Its first foray into the American IOL market is a pretty neat advance. The iSert Preloaded IOL Injection System ($135 to $145 per kit)?seems to offer a more efficient, more predictable solution than manual handling. It takes about 8 seconds to prepare this sterile, self-contained, single-use injector, which sidesteps not only the risk of misloading and damaging the lens, but also of spreading TASS through the use of reprocessed insertion instruments. The iSert injects aspheric, hydrophobic blue-blocking or UV-absorbing acrylic lenses through a 2.4mm incision.

New approaches
As a technique for cataract surgery, microincision has been something of an ideal goal complicated by practical inconsistencies. For example: What's the point of using 1.8mm IOLs if you need a larger incision to accommodate your tools? Bausch & Lomb's Microincisional Cataract Surgery (MICS) system now offers a start-to-finish platform to meet this goal. From its Stellaris Vision Enhancement System and Akreos AO Microincision Lens to its Storz Ophthalmic Instruments and Amvisc Plus Viscoelastic, each component is designed and built around a 1.8-mm incision. The company says there's no increase in price in choosing 1.8mm over 2.2mm or 2.8mm compatible equipment. Is this just an incremental improvement? Perhaps. But to those who swear by microincision's faster healing and reduced risk of post-op astigmatism, the availability of a uniform system opens the gates to greater efficiency and outcomes.

Abbott Medical Optics has also tweaked its phaco platform with improved motion at the tip. Ellips FX Transversal Ultrasound technology, available on all AMO tip styles for the Whitestar Signature system, combines side-to-side and longitudinal action into an elliptical motion. This effect is said to improve cutting efficiency and offer smoother and more efficient lens removal across a larger area without requiring the user to change his technique. The Ellips handpiece lists at $5,000. Trade-ins are possible for existing customers seeking to upgrade their equipment.

Cornea considerations
If you've yet to see Descemets Stripping Endothelial Keratoplasty (DSEK) procedures, you may soon. Replacing an eye's diseased or damaged endothelial cell lining with donor tissue offers faster healing and vision improvement than a whole-cornea transplant does. Two new products stand to bring added precision and consistency to the process.

The Tan EndoGlide System from Angiotech employs a reusable forceps and single-use preparation base, glide cartridge and glide introducer, which have been engineered to handle and insert the harvested endothelial tissue with minimal damage to its delicate, non-regenerating cells. The sterile-packaged, single-use system lists at $225 and the titanium forceps at $1,350.

In addition to its Visco Shield Topical, a preservative-free viscoelastic that can keep the cornea hydrated for up to 20 minutes ($78 for a half-dozen 1.5mL syringes), Oasis Medical also announced its distribution of the Macaluso DSEK/DSAEK Endothelium Inserting Device by Italian instrument manufacturer E. Janach. The tissue transplanting instrument, which is loaded with a forceps, is designed to work as a closed system and to seal the eye upon insertion. It lists at $2,242.

Once the donor tissue has been inserted, Topcon's MicroSlit Illuminator ($10,000), an attachment for its OMS-800 surgical microscope and selected Zeiss models, aims to verify its proper placement and adhesion. A thin beam of LED light projected at a 30-degree inclination (the fixed angle at which the attachment is mounted to the scope) and the resulting imaging show whether the tissue has adhered evenly to the cornea or whether bubbles or irregularities require smoothing out. Most U.S. DSEK procedures are done without the assistance of slit illumination, the company says, but they note that European physicians have noticed a reduction in post-op complications, revisions and failures through the use of the technology.

The turnaround
When the case or the day is done, you've got to reprocess your instruments. SciCan's Bravo fractionated vacuum chamber autoclave combines the versatility of flash sterilization cycles for wrapped and unwrapped, solid and hollow instruments, with the speed of rapid cycle times and vacuum heat drying. Available with a 17- or 21-liter chamber, the Bravo features single-button operation, continually monitored and clearly displayed cycle parameters and an optional internal printer or external data recorder for cycle documentation. It starts at $7,800.