Given Medicare’s addition of several orthopedic procedures to its fee schedule, an increasingly graying population and a post-COVID effect that has predisposed...
I love playing with new stuff, and there was plenty to play with at this year's American Society of Cataract and Refractive Surgeons conference in San Diego. I was like a kid in a candy store, only I was looking at eye drops instead of gumdrops and lasers instead of licorice. Here's some of what caught my eye.
The TrueGuide is really 3 tools in one. There's pre-operative information management and planning, an intra-operative microscope, and overlay and dynamic customization. The heads-up display is helpful from an ergonomic standpoint, and it lets the whole OR see exactly what you're doing. The 3D visualization is tremendous. It also stores a tremendous amount of information — just about everything that might possibly be helpful. All in all, it's definitely fun to play with and it's going to provide a benefit when it comes to astigmatism location.
LenSx for LASIK
The new Alcon machine has a button that says "flap," so to switch from laser to LASIK, all you have to do is log out, hit the button, log back in and wait about 10 minutes. That's a great innovation and one that I hope will pull more LASIK procedures into surgery centers, which in my opinion are the safest places for them. I like knowing that I have an accredited OR that's following safety guidelines and that an independent person has verified that. This machine provides added flexibility for a cataract and refractive surgeon.
The company expects FDA approval shortly for its pattern photocoagulator, which it bills as having a pattern and wavelength for every pathology. Patterns can be customized for shape, size and rotation, and the touchscreen interface allows for easy adjustments of all treatment parameters. It's easy to use, and by delivering up to 25 laser shots in half of a second, it dramatically shortens what can be a long process. Hey, maybe I can get rid of my retina guys.
Dutch Ophthalmic's recently approved all-in-one phaco/vit machine can be a real asset, considering how expensive retina machines are on their own. As every surgeon knows, the volume is in cataracts, but it's also helpful to have retina capability, and this has high-end phaco and retina capacity. It's a one-touch setup and everything is color-coded, so setup time is fast and turnover time is reduced, according to the rep. With both peristaltic and vacuum options, you can choose whichever pump is most advantageous. It also has economical LED illumination. Retina requires disposable tubing, but the reusable tubing and needles for phaco are another plus.
The same company that created the Dropless formulations introduced a new portfolio of drop formulations at the show, one that uses the same technology. The LessDrops line includes various combination drops, including prednisolone and moxifloxacin; prednisolone and ketorolac; and prednisolone, moxifloxacin and ketorolac. The approach cuts costs and improves patient compliance by reducing the need for multiple drops. I've seen patients choose inferior lenses because their drops were so expensive. Combining 2 or more drops in one — if, say, a patient needs both a steroid and an antibiotic — can dramatically reduce that burden. The drops are sold on a per-patient basis, so you can't keep them on the shelf, but you can either have the drops shipped to your facility and charge the patient, or patients can use credit cards and have the drops shipped directly to them. This is a win-win-win for everyone.
Phenylephrine HCl Ophthalmic Solution
There's some much-needed competition in the phenylephrine market again, now that Akorn has its own unique FDA-approved formulation. It's still a lot more expensive than it was before the FDA got involved (we went from paying $7 to $70), but Akorn's entry into the market is bound to help. The difference with Akorn's product? It doesn't have to be refrigerated and it comes in 3 sizes: 2 ml and 15 ml vials of 2.5% solution and a 5 ml vial of 10% solution. Akorn is promising to cut that $70 price tag almost in half, at least for the 5 ml vial. Amazing what a little competition can do.
Omeros' new FDA-approved combination of phenylephrine and ketorolac is a useful addition in a couple of ways. For one, drug shortages have made phenylephrine hard to find, but it's definitely a plus when it comes to keeping pupils dilated, especially with difficult patients — for example, those who take Flomax, those with small pupils and those with pseudoexfoliation. It comes in a 4 ml vial that can be added directly to the BSS solution. So you're promoting dilation as you irrigate the eye, and the ketorolac dramatically reduces post-op pain. It's expensive ($465), but it's reimbursed by Medicare as a pass-through product, and Omeros has a great patient-assistance program in case you run into difficulty with financing. The only caution: You need to make sure you don't have patients who fall through the cracks and leave you on the hook for the full cost.
Oertli's CataRhex3 phaco machine, which is being distributed in the United States for the first time by Katalyst Surgical, is small enough to take on a plane as a carry-on. At about 11 pounds, it can be suspended from any IV pole and it can be set up in seconds, according to the rep. It's also powerful, with the capability to be programmed for up to 20 surgeons. To me it looks promising. A lot of phaco machines have bells and whistles this one doesn't have, and I like that simplicity. But I'd have to try it out to know for sure. One concern is that it uses disposable tubing, which runs about $50 per case, or $75 if you include disposable tips. Multiply that by 3,000 cases a year and it gets pretty expensive. That's why I prefer reusable tubing when it's available.
This could be an excellent solution for surgeons with space issues. It's a stand-alone laminar down-flow installation that uses 2 front filter sets and a HEPA filter to create a sterile surgical working area. The sterile airflow blows directly onto the operating surface, so the surgical team can move around freely without affecting the sterile field. Most efficient cataract surgeons have 2 ORs. With this, you can make a procedure room function like a sterile OR, which could help you feel more comfortable using a procedure room for cataract surgery and also free up your sterile OR for more complex procedures. The rep says the European-based company is working on FDA approval and hopes to be doing business in the United States shortly. The price depends on the space available and the size, but is likely to be in the range of $60,000 to $100,000.
Premier Edge Safety MVR Scalpel
Oasis has added a little more grip to the thumb slide on its line of patented one-handed safety scalpels, making them easier to use. They've also taken weight and view into consideration, so it's well-balanced and the shield retracts far enough out of the way that it doesn't block your view. The slide and click tell me the shield is in place, so I can comfortably hand it off without having to look away. As single-use disposables, these won't take the place of diamond blades, but they're nice to have when you send diamond blades out for repair.
I-Ring Pupil Expander
Just released, the I-Ring Pupil Expander is made from pliable polyurethane. I like the design. It's rounder, so it maintains 360-degree contact and is gentler on the pupillary margin. We're seeing more and more floppy iris syndrome, and this provides a convenient solution. Insertion and removal are easy and intuitive, and it's designed in such a way that Sinskey hooks don't come into contact with the iris.
FOR YOUR EYE SURGEONS
- The Allegro from MicroSurgical Technology is a convenient preassembled single-use I/A system that's designed to provide better access to the subincisional cortex. It's made of silicone, so it's less likely to break the posterior capsule. A reusable handpiece is included.
- Accutome's AccuSharp Guarded Blades feature smooth, single-handed blade retraction, superior sharpness and an ergonomic handle design. This single-use guarded metal blade product line is available in slit, crescent, MVR, LRI and stab blades.
- Pushing the boundaries in perimetry, the Humphrey Field Analyzer 3 from Carl Zeiss features intelligent software that adapts to the patient, and a liquid lens that instantly delivers each patient's refractive correction, saving setup time and improving overall accuracy.
- The LENSAR Laser System with Streamline is a suite of 5 new application technologies, including a wireless integration protocol with pre-operative diagnostic devices, an arcuate incision planning table based on individual patient biometric measurements and other factors, and the ability to categorize cataracts using a pre-programmed, surgeon-customized fragmentation pattern.
- Tecnis iTec from Abbott Medical Optics, preloaded IOLs that you can deliver via a small incision (2.2 to 2.4 mm), reduce the stress on surgeons and technicians responsible for loading IOLs, eliminating infection risk and saving time — about a minute per procedure. So far, only monofocal lenses are preloaded, but the company expects to add other types.
- Optos has added California Ultra, a new imaging modality with indocyanine green angiography, to its tabletop ultra-widefield retinal imaging system, as well as several software and hardware enhancements, including ProView, which helps track retinal disease progression over time.
- Bausch & Lomb's Victus Femtosecond Laser is a vivid and versatile femto that lets surgeons perform capsulotomies, fragmentation, arcuate incisions, corneal incisions and LASIK flaps. Swept source optical coherence tomography and an easy-to-use graphic interface provide high-contrast visual guidance.
- The Cyclo G6 from Iridex uses Micropulse technology to perform cyclophotocoagulation, which lets tissue cool between pulses, thereby reducing tissue damage and other complications. Patients are able to go to work the next day, says the rep.
- Katena's new Double-X speculums feature a "double-X" mechanism that opens lids in a parallel motion, so there's minimal external pressure on the globe. Additionally, as the blades open, the mechanism moves away from the surgical field, providing unobstructed access to the field.