The American-European College of Ophthalmic Surgery Summer Symposium in Deer Valley is a unique meeting that features physician, industry, and even regulatory leadership in a collaborative and highly productive environment.
The American-European College of Ophthalmic Surgery Summer Symposium in Deer Valley, Utah, kicked off with Steven Dell, MD, and Stephen Slade, MD, discussing hot topics that included how to price premium services and how to present the costs to patients. The way in which new technologies are presented to patients is key, and not all physicians are comfortable selling services and discussing price.
“Case Presentations,” where physicians share innovative new techniques and pearls, provide some of the most valuable content for the meeting. William Trattler, MD, presented a case (Case That Appears Risky for Ecstasia: Would You Touch This?) that featured a 21-year-old woman with mild inferior steepening (OS > OD) and low myopia (-3.00 D with 1.00 D of astigmatism). The inferior-superior ratio was 0.68 OD and 1.77 OS with a corneal thickness of 486 µm OD and 483 µm OS. The back elevation on the Pentacam (Oculus) was normal; however, the percentage of thickness increase was abnormal. The following discussion ensued.
The patient was young with suspicious findings for forme fruste keratoconus. Although she may be eligible for PRK, her age and thin corneas skewed the discussion toward intervention with corneal cross-linking (CXL). Physicians commented on how young a patient can receive CXL, regardless of evidence of progression.
Sheri Rowen, MD, led a discussion on IOL implantation in a patient with severe dry eye disease. The patient had presented with extremely red eyes, uncontrolled blepharitis, severe photophobia, and a 3.00+ D nuclear sclerotic cataract on which no previous surgeon was willing to operate. Treatment included cyclosporine A (Restasis; Allergan) and LipiFlow (TearScience). Once the cornea cleared, topography was repeated, and the original choice of a 23.50 D Crystalens (Bausch + Lomb) was changed to a 23.50 D Trulign (Bausch + Lomb). The take-home point was how drastically dry eye disease will negate proper topography and the importance of addressing the ocular surface before choosing lenses.
Microinvasive Glaucoma Surgery
Steven Vold, MD, presented the most recent data on the CyPass Micro-Stent, a microinvasive glaucoma surgery device that is hoping to make it to market. Dr. Vold reported that patients who received the stent in conjunction with cataract surgery saw a 30% to 40% lowering of IOP, and the vast majority were able to cease all drops. William Wiley, MD, reported that he has been combining endoscopic cyclophotocoagulation with the iStent Trabecular Micro-Bypass (Glaukos) to give his patients the lowest IOPs. He noted that endoscopic cyclophotocoagulation is relatively inflammatory, so he makes use of intraocular injections of Tri-Moxi-Vanc (Imprimis Pharmaceuticals) or nonsteroidal anti-inflammatory drugs to control inflammation on the front end.
Mitch Jackson, MD, and Dee Stephenson, MD, discussed options for patients with small pupils, sometimes so small as to prevent the effective docking of a femtosecond laser. They both recommended using Omidria (phenylephrine 1% and ketorolac 0.3% injection; Omeros) intracamerally as part of the irrigating solution and mentioned the utility of pupillary expansion devices. APX Ophthalmology’s device enters through the sideport incision and in one motion retracts the iris.
With the first corneal inlay for the treatment of presbyopia approved by the FDA during the past year, John Vukich, MD, discussed ideal candidates for the Kamra technology (AcuFocus). Emmetropic presbyopes who are plano or slightly minus do best, and performing LASIK to get the patient to this point is an option. The Kamra inlay is placed in the nondominant eye, but it is not a monovision technique and it does not alternate suppression. Dr. Vukich also points out that serving the desired patient population requires the surgeon to reach out to referring colleagues, patient networks, and local (or social) media to get the word out about this exciting option.
Ocular Surface and Cataract Surgery
Priyanka Sood, MD, directed the discussion of severe meibomitis/blepharitis in patients contemplating cataract surgery. The primary takeaway point was that clinicians severely undertreat these diseases, and patients are at risk of developing further fibrosis that will only make treatment more difficult.
In addition to the tools ophthalmologists have, such as Restasis, there are a variety of new options that can also work.
Cliradex Advanced Care Gel (Cliradex) is part of an in-office hygiene protocol that uses a new tea tree oil formulation that isolates 4-Terpineol, to improve the miticidal effects and reduce allergic reactions and toxicity.
Avenova (Novabay) is a prescription hypochlorus solution with potent antibacterial activity that was used in the past to treat wound infections.
MiBo Thermoflow (MIBO Medical Group) is a new device that uses a thermal pulsation technique to clear the meibomian glands at a lower price point than the alternative.
BlephEx (BlephEx) is a medical-grade microsponge used to exfoliate the lid margin and eliminate the debris associated with inflammation. Patients should be encouraged to come in every 6 to 8 months to have their lid margins exfoliated with these new devices.
Physician discussion also included the benefits of offering omega-3 fatty acids and other treatments in the practice to improve patient access and compliance while also generating income.
Go to eyetube.net/series/daily-coverage-aecos-deer-valley-2015/idohu to view daily coverage videos and more from the AECOS 2015 Summer Symposium.