Ophthalmology Focuses on Precision
Innovations for 2013 provide better data, visualization and control.
Steven Vold, MD
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.
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