The exhibit hall at the American Society of Cataract and Refractive Surgeons' annual conference in San Francisco in April was a treasure trove of innovation. I saw big visualization and measurement systems, multi-functional lasers, neat new tools for glaucoma and cornea — even a new crop of premium IOLs, an area that's been slow the past few years. Read on to see what caught my eye (and there was plenty) in this year's exhibit hall.

Centrasight from VisionCare
Hands down, the coolest thing I saw on the show floor was VisionCare's Centrasight, a stunning little piece of technology the thickness of 5 IOLs stacked on top of each other that has the potential to really change lives. Centrasight is a sight-saving mini-telescope implant for patients with end-stage age-related macular degeneration (AMD). The only FDA-approved telescope prosthesis, it works with the cornea to enlarge images in front of the eye up to 2.7 times their normal size. This magnification in turn reduces the effect of the blind spot patients experience in their central vision due to scotoma associated with AMD.

The company provides training for patient selection, the surgery itself and rehabilitation. But the FDA has limited approval only to cataract surgeons with cornea training. If you or someone in your facility fits the bill, I recommend checking into it. Medicare has proposed to provide reimbursement for Centrasight. CMS would assign the telescope implant procedure (CPT code 0308T) to a new Ambulatory Payment Classification (APC) 0351, Level VII Anterior Segment Eye Procedures, with mean cost calculated using claims data available for the final rule. If finalized, the new APC would be effective Jan. 1.

ORA System from WaveTec Vision
WaveTec Vision, the company that pioneered intraoperative wavefront sensing in the United States, is back with the ORA System, an upgraded system that takes the technology to a new level. There are other measurement and guidance systems, and they're good — but the ORA (Optiwave Refractive Analysis) intraoperative aberrometry/refractive wave analysis system was a must-see for me, and boy did it deliver.

The ORA itself was launched in 2011. The new innovation is called VerifEye. It features continuous 3-camera monitoring to provide refractive information and astigmatic feedback. And it all now operates in real time (there used to be a short delay) The idea is that stable refraction will let the surgeon optimize the conditions of the procedure (including precise toric IOL power selection and placement in aphakic and pseudophakic states), leading to the best possible results.

Surgeons like to think they've perfected their techniques. I should know, I'm one of them. But I think the wave (pardon the pun) of precision-assistance technology will see a system like this for ensuring measurement and IOL placement in every ophthalmic OR.

Callisto Eye from Zeiss
If your surgeons have Zeiss's Opmi Lumera 700 microscope, they're going to want to add Callisto Eye, an auxiliary user interface that lets the surgeon and the OR team control the surgical microscope, import patient lists, display information, export video and still images and, with the deluxe version, enhance precision using a number of functions.

The "basic" package delivers the kind of integrated management that I think will soon become standard, with features including viewing the microscope parameters in the eyepiece and video frame display in the eyepiece to help define the video recording field of view. The "deluxe" package expands on those capabilities with visualization and measurement tools. For example, Calisto Eye Assistance provides guidance for aligning toric IOLs, positioning incisions and achieving precise capsulorhexis every time. The nurse runs the interface on a user-friendly touch screen, and the surgeon sees all the measurements through the microscope.

Lumenis's Selecta Trio
If you want to upgrade your laser room, this is the year to do it. More combination lasers are on offer, along with a cool technology focused on treating diabetic eyes — which I'm surely not alone in seeing more of.

Lumenis's Selecta Trio is a multi-modality laser that puts retinal, cataract and advanced glaucoma therapies in 1 package. The Trio's integrated design, enhanced optics system and advanced laser cavity give you flexibility, and enhance precision and safety. I can see the advantages of having SLT, YAG and photocoagulation in 1 footprint, particularly where space is at a premium.

The Quantel Vitra Multispot laser is a 532nm photocoagulation laser for Haag Streit-type slit lamps that combines advanced pattern-scanning technology with a solid-state green laser in 1 platform. The laser is administered in pulse durations of 10 to 20 microseconds to multiple spots over various patterns, including squares, lines, circles (partial and complete) and triple arcs. This results in shorter treatment times with less collateral damage than with conventional lasers.

As for combination lasers, brand new to the market (for sale as of July) is Ellex's Tango SLT/YAG Combination System, which features a dual-mode laser cavity and combines a full-featured selective laser trabeculoplasty (SLT) laser with a precise, powerful Nd:YAG laser for performing iridotomy — which can help surgeons better manage POAG and PACG. The physician can switch between SLT and YAG modes at the touch of a button. Ellex reps say Tango's 3-hertz firing rate is the world's fastest, and that the device will deliver 400,000 shots.

Over in the laser cataract arena, upgrades were the name of the game. Alcon has expanded its LenSx femtosecond laser platform with the addition of the SoftFit Patient Interface, a single-piece interface designed to work with the curve of the cornea to conform to a soft lens insert, says the company. SoftFit automates the data gathering to render the cornea with less distortion, which might open laser refractive cataract surgery to a wider variety of patients.

The LensAR (the AR stands for "augmented reality," which uses optical-ray tracing to produce a 3-D image of the eye) Laser System was initially approved by the FDA in 2011, and it got clearance April 3 for arcuate incisions during cataract surgery. Bausch & Lomb's Victus Femtosecond Laser Platform also received FDA approval for arcuate corneal incisions in March, so it can now support both cataract and corneal procedures in 1 platform. These curved incisions are made on the periphery of the cornea, which makes both femtosecond laser platforms all the more flexible.

G-Probe from Iridex
Last year, Iridex's big launch was the IQ 532 Laser System; this year, it's the G-Probe, a glaucoma device that performs transscleral cyclophotocoagulation (TSCPC) to lower IOP by selectively ablating the ciliary processes. The procedure can be done on its own in the laser room, or in concert with other procedures such as cataract surgery, and is a "viable alternative to trabeculotomy for moderate to severe glaucoma cases," says the company.

I don't mean to brag, but it is fun to see your own device launched on the show floor at ASCRS. Without making a commercial of it, I'd like to at least mention Transcend Medical Vold Gonio Lens for micro-invasive glaucoma surgery, which is designed to increase precision and stability during ab intero procedures with intraoperative gonioscopy.

New World Medical presented the Model M4 Glaucoma Valve, which is constructed from a biocompatible, porous polyethylene shell and manufactured with a specified pore size. The material lets soft tissue grow in the pores, which logically should promote integration with the surrounding tissue and encourage vascularization of that tissue. It's a non-obstructive system for controlling IOP, and the company says the Model M4's tapered profile makes for easy insertion.

Endoglide from Angiotech
If you do have to perform a cornea transplant, you want to have verification of endothelial cells and to minimize the risk of infection. To that end, Angiotech has developed Endoglide, a delivery system preloaded with cornea tissue that's verified and loaded by eye banks the company works with. Because of their expertise, the company asserts, eye bank staff are less likely to damage tissue when loading the injectors than are OR techs who may not be doing the procedure regularly. According to a pre-clinical study, tissue injected by Endoglide averaged just 9.1% endothelial cell damage, compared with 36.2% in tissue loaded on site. Further, the loading is done under sterile conditions, which might minimize the potential for infection. With no handling to be done in the surgical facility, all the surgeon has to do is inject the tissue with the simple, single-handed device.

AmbioDisk from IOP Ophthalmics is a suture-less amniotic membrane and a simple overlay for the ocular surface. It can be used to treat non-healing epithelial defects, neurotrophic ulcerations, corneal erosions, acute burns and post-infectious keratitis. The intact epithelial, columnar cell matrix is said to help maintain an "intact dense basement membrane" and provide a "loose collagen layer bordered by retained fibroblasts." The goal is to prevent further damage to the cornea and reduce the need for corneal transplant down the road. "It's an outpatient procedure that's preventive medicine," said one of the reps, which is a tidy way to summarize — after all, AmbioDisk costs less than half the $10,000 cornea transplants run.

Katalyst and Katena
Building on the rising popularity of laser cataracts, Katena has come out with a new femtosecond instrument range. Katalyst had several new carbon-fiber picks that — due to a proprietary material that's stiff, resistant to damage and able to be finely honed — don't bend at the tip, so they let the surgeon feel what's happening in the eye.

Safety Knives from Surigstar
Surgistar launched single-use, single-handed safety knives of all sorts: stab (15 ? to 45 ?), crescent (2.0mm, straight and bevel-up), slit (1.8mm to 2.8mm, angled) and MVR/sideport (0.5mm to 1.0mm, straight and angled) knives.

Tecnis Toric 1-Piece IOL from Abbott
IOL development has been stagnant for a few years now, but freshly approved when we were at the show was Abbott's Tecnis Toric 1-Piece IOL, to treat cataract patients with pre-existing corneal astigmatism. The lens, an addition to the longtime line of various IOLs under the Tecnis name, can be used in patients with astigmatism of 1 diopter or greater. Abbot also brought a new viscoelastic out to play: the Healon Duet Dual Pack. The combination pack delivers the cohesive Healon OVD and dispersive Healon EndoCoat OVD in one box, essentially, for the surgeon's convenience in the OR.

Bausch & Lomb is tackling "glistenings" — tiny, fluid-filled bubbles that form in the IOL and hinder vision post-op — with enVista. The hydrophobic acrylic IOL is said to be entirely glistening-free due to B&L's aberration-free aspheric "advanced optics." The design has also shown good results when it comes to preventing PCO and IOL movement within the bag.

Lenstec's Softec HD Oval is so named because of the oval center measuring 5.75mm by 6.5mm, which provides almost 30% more coverage across the visual plane compared to standard IOLs, says the company. Not only is it the first oval, single-piece, foldable IOL, it's also the largest, single-piece, foldable IOL on the market.

Hoya's iSymm and the preloaded iSert are clear, foldable, hydrophobic, acrylic-optic IOLs. The optimized aspheric design is meant to provide negative spherical aberration along with central power distribution that maintains image quality with misalignment, says the company.