Ophthalmologists eye photonics at annual meeting

ATLANTA, GA--At the 2008 American Academy of Ophthalmology (AAO) annual meeting, held November 7–11 in Atlanta, optical coherence tomography (OCT) was well represented both in the conference program (with several sessions dedicated to the topic and several more touching on it) and in the exhibit hall, with Bioptigen, Carl Zeiss Meditec, Heidelberg Instruments, OPKO, Optopol, Optovue, and Topcon all exhibiting--most with large booths. In fact, Zeiss’s 100 ft. x 100 ft. booth was the second largest at the event, where several pharmaceutical companies also dominated. Bioptigen’s display was small, but drew quite a crowd as the company demonstrated its research-targeted unit, the only portable OCT device yet available.

Canon joined the OCT crowd too, having recently inked a distribution deal with Optopol, so Optopol’s technology got double the exposure through its own and Canon’s exhibit. Nidek wasn’t talking about its rumored OCT offering, but I’m guessing that company will have released an OCT system within a year. Of course the exhibitors emphasized eye care, but there was talk among some of OCT for other disciplines, including non-biomedical applications such as manufacturing.

A 2–1/2 hour OCT session that required additional payment drew an audience of more than 200. When the moderator asked how many attendees currently have OCT systems, most raised their hands--and about 25% indicated they own spectral domain (Fourier domain) OCT systems. Not surprisingly, most of the attendees are focused on retinal applications, but about 15% or so use OCT for corneal work.

An overview of OCT emphasized the speed difference between the older time-domain units and the new breed of spectral/Fourier domain systems--but it was noted that the real bottleneck these days for OCT is computer processing time. That’s why an announcement by Texas Instruments, made a week or so later, is so exciting: TI’s new embedded processors specifically target medical imaging.

In September Zeiss announced a milestone of 10,000 OCT system placements worldwide, and following AAO Optovue announced its own milestone, saying it has now shipped more than 1000 RTVue systems since its introduction two years ago. RTVue claims to be the first and only FDA-cleared spectral domain OCT capable of imaging both the front (cornea) and back (retina) of the eye in a single system. Zeiss’s Stratus was the original time-based OCT system and so the company has dominated the arena. When asked how its market share has held up, Zeiss company representatives indicated only that the market has expanded substantially. Another exhibitor guesses that Zeiss has gone from about 85% market share to about 80%.

Product introductions

Carl Zeiss Meditec (Dublin, CA) announced new and updated products addressing diagnostic and surgical applications covering the entire spectrum of patient care and supporting all major ophthalmology segments: cataract/refractive, retina and glaucoma. Its two new systems are the OPMI Lumera i Surgical Microscope and the VISULAS Trion Combi System, which Zeiss says is the world’s first multi-color photocoagulator (it uses yellow, red, and green wavelengths) paired with a photodisruptor for complete retina treatment.

Zeiss debuted Acri.LISAtoric, “the world’s only multifocal toric MICS IOL,” at AAO. The Acri.LISAtoric is based on the well-known optical concept of the Acri.LISA which has shown in studies that the vast majority of patients, in some studies more than 90%, no longer need corrective glasses at all after cataract surgery. The Acri.LISAtoric is not yet approved for sale in the U.S.

Zeiss says that in November, its IOLMaster similarly reached a landmark 10,000 installations. IOLMaster Advanced Technology Software Version 5 increases the number of patients that can be measured for intraocular lenses (IOLs), while the updated Cirrus HD-OCT Review Software promises to speed analysis and streamline office workflow. Indeed, enabling increased patient volume was a theme in the exhibit hall.

Among other laser equipment companies exhibiting at the event were Advanced Medical Optics (AMO, Santa Ana, CA) which last year broadened its reach into refractive surgery by acquiring IntraLase; and Lumenis (Yokneam, Israel), which introduced four new ophthalmic lasers and delivery devices during the event: a small-footprint unit that enables retinal, cataract and advanced glaucoma therapies; an anterior-segment laser that combine YAG and SLT technologies; plus a powerful dual-port photocoagulator; and a family of endo photocoagulation laser probes for retinal applications.

Ellex Medical Lasers (Adelaide, Australia) previewed a new system (set to debut in 2009) that combines 1.5 W of 561 nm yellow light and 1 W of 670 nm red light--wavelengths and power not previously available in photocoagulators. Compared to traditional 514/532 nm green, Ellex says the 561 nm yellow creates a more gentle retinal burn and results in low scotoma formation. Also during AAO, Ellex announced results of a six-month clinical study for Retina Regeneration Therapy. This treatment uses Ellex’s 2RT laser, a custom-designed, Q-switched green YAG laser that produces very precise, three-nanosecond pulses of 532 nm light energy. The study showed that 2RT is clinically safe and effective in the treatment of macular edema secondary to diabetic retinopathy. “This is a revolutionary treatment because, for the first time, we can obtain all the therapeutic benefits seen with earlier laser treatments, but without the collateral damage,” said professor John Marshall of St. Thomas’ Hospital, London, who led the study.

--Barbara Goode