A NEW ANGLE It doesn’t always take heavy equipment to innovate cataract surgery.

Given the choice between a pupil expander and a femtosecond laser, Jeffrey Whitman, MD, president and chief surgeon at the Key-Whitman Eye Center in Dallas, Texas, would choose the pupil expander. “It will let me do any case,” he says. “I couldn’t use a laser on smaller pupils.”

Big-ticket items like lasers and wavefront abberometers may win all the hype, but many recent innovations in ophthalmic supplies improve the safety and efficiency of cataract surgery. These devices “can turn a potentially difficult surgery into something more manageable,” says Dr. Whitman. “Anything you can do to make surgery easier and safer is worthwhile.”

Here’s a roundup of 7 products that save time and improve outcomes.

Given the choice between a pupil expander and a femtosecond laser, Jeffrey Whitman, MD, president and chief surgeon at the Key-Whitman Eye Center in Dallas, Texas, would choose the pupil expander. “It will let me do any case,” he says. “I couldn’t use a laser on smaller pupils.”

Big-ticket items like lasers and wavefront abberometers may win all the hype, but many recent innovations in ophthalmic supplies improve the safety and efficiency of cataract surgery. These devices “can turn a potentially difficult surgery into something more manageable,” says Dr. Whitman. “Anything you can do to make surgery easier and safer is worthwhile.”

Here’s a roundup of 7 products that save time and improve outcomes.

Omeros Corporation
Omidria
(phenylephrine and ketorolac injection) 1% / 0.3%
omeros.com
Pricing: not disclosed
FYI: Scheduled for a U.S. product launch in the fourth quarter of 2014, the Omeros Corporation’s recently FDA-approved drug Omidria offers to solve 2 cataract surgery complications at once: intraoperative pupil constriction and post-operative pain. A mydriatic (pupil-dilating) agent maintains the opening’s size consistently, while the anti-inflammatory ketorolac eases recovery and reduces the need to administer pre-operative NSAIDs. Added to the ocular irrigation solution in use during surgery, this proprietary compound facilitates predictable procedures without the need to change surgeons’ techniques or routines, says the company.

Imprimis Pharmaceuticals
Dropless Cataract Surgery
dropless.com
(858) 704-4040
Pricing: Single-use, 2 mL vial of Tri-Moxi: $20. Single-use, 1 mL vial of Tri-Moxi+Vanc: $25.
FYI: The antibiotic, steroidal and non-steroidal eye drops that patients are prescribed after cataract surgery are essential to optimal outcomes, but they’re dependent on patients sticking to their inconvenient schedule, administering them 3 times a day for as long as 3 weeks. Imprimis’s proprietary compounded formulations prevent the risk of post-op infection and inflammation while simplifying patients’ care by doing away with post-op drops. A single intraoperative injection of Tri-Moxi (triamcinolone acetonide and moxifloxacin hydrochloride) or Tri-Moxi+Vancomycin into the vitreous enables the delivery of the meds over time and guarantees compliance with the post-op care regimen and consistent results. Prepared and tested under the supervision of a licensed pharmacist, the formulations are cost-effective alternatives to branded drops.

Diamatrix
Xpand Iris Speculum
diamatrix.com
(800) 867-8081
Pricing: between $95 and $120 each, depending on quantity
FYI: If pharmaceutical dilation isn’t an option, mechanical dilation of the pupil is necessary. The Malyugin ring has been the standard bearer on this front since its introduction a few years ago, but a pair of new entries in the category offer functional and price-point alternatives. Diamatrix’s Xpand Iris Speculum’s 8-point fixation opens a circular 8 mm pupil with minimal trauma without adding much in the way of case costs or surgical time. The sterile, single-use device is positioned and removed through a standard minimally invasive cataract surgery incision with a cartridge and injector system (included).

Oasis Medical
Iris Expander
oasismedical.com
(800) 528-9786
Pricing: not disclosed
FYI: The other new mechanical pupil dilation device competing with the Malyugin ring is Oasis Medical’s Iris Expander. The molded polypropylene ring’s 4 pockets cradle iris tissue without pinching or clamping to ensure intraocular access and visibility during surgeries in which patients suffer from miosis, intraoperative floppy iris syndrome or other conditions resulting in inadequately dilated pupils. The sterile, single-use Oasis expanders are available in 6.25 mm and 7 mm sizes, and the company’s specially designed disposable inserter is pre-attached to the ring inside of its protective packaging.

Bausch + Lomb Storz Ophthalmic Instruments
Osher Sterile Field Magnifier
storzeye.com
(800) 338-2020
Pricing: $350
FYI: Everything in ophthalmology is tiny. This compact magnifier, ideal for supply stand use, can give your OR staff an improved view when accuracy and precision are on the line. Its 50 mm lens can assist in loading IOLs, aligning irrigation sleeves on phaco or irrigation/aspiration tips, and inspecting and differentiating microsurgical instruments. The stainless steel and optical glass magnifier is easily cleaned and safe for the autoclave. Its lens folds into the base, allowing it to fit in most surgical instrument trays.

Ocular Therapeutix
ReSure Sealant
ocutx.com
(877) 628-8998
Pricing: 5-unit box, $500; 10-unit box, $900.
FYI: Ophthalmic surgeons try to avoid suturing corneal incisions after cataract surgery. They’re usually self-sealing, for one thing. In addition, suturing can affect astigmatism correction outcomes, can be uncomfortable for patients, and has to be removed. Sometimes closure is necessary, however, to prevent fluid leakage. This first-of-its-kind ocular surgical glue is a safe and easy alternative for adult patients. The sealant gel is formed by mixing 2 liquids immediately before use, then applying it to the cornea. It dissolves in a week, dissipated by tears.

Akorn
Akten
(lidocaine hydrochloride ophthalmic gel) 3.5%
akorn.com
(800) 932-5676
Pricing: not disclosed
FYI: This viscous topical gel delivers extended, localized ocular anesthesia to any eye procedure. A drop or 2 takes effect in 20 to 60 seconds and lasts for 5 to 30 minutes, a time- and expense-saving alternative to off-label intracameral injections of lidocaine 2% jelly. It also spares patients the discomfort of the block injections. The water-soluble, preservative-free, room-temperature gel can be easily reapplied for longer cases. Upon its introduction several years ago, it was sold in sterile 5 mL vials, but its current, smaller portioning in sterile 1 mL tubes reflects the safety concerns surrounding single-use pharmaceutical packaging.

TECH DEAL
Alcon to Purchase WaveTec Vision’s ORA System

CATCH THE WAVE Alcon plans to add WaveTec’s ORA System to its suite of cataract refractive technology.

WaveTec Vision’s ORA intra-operative guidance system is on a lot of eye surgery centers’ wish lists. It was apparently on Alcon’s, too: The ophthalmic manufacturer announced plans last month to acquire the company and its diagnostic technology. Financial details were not disclosed.

The ORA System collects wavefront data during cataract and refractive surgery to provide physicians with real-time measurements that verify intraocular lens power and the accuracy of the implants’ placement. Alcon plans to integrate the technology into its cataract refractive suite, which includes the LenSx femtosecond laser, Centurion phacoemulsification system, LuxOR LX3 microscope and Verion measurement and digital marking system which, the company notes, the ORA complements.

“The marriage of the ORA System and Alcon’s Verion image-guided system is intended to increase the surgeon’s clinical confidence when using IOLs,” says Alcon. “Ultimately, the combined technologies are designed to improve patient outcomes and enhance the overall post-surgical patient experience with IOLs.”

— David Bernard