OPHTHALMOLOGY: Eye docs eye imaging, laser systems

Between laser surgery techniques and imaging methods, such as optical coherence tomography (OCT), optics and photonics made up a sizable portion of the conference content and exhibit hall at the American Academy of Ophthalmology (AAO) annual meeting 2008. The event drew approximately 22,000 attendees to Atlanta, GA, Nov. 7–11.

OCT was discussed both in conference sessions dedicated to the topic and in others with a more general focus. A dedicated session 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% use OCT for corneal work.


AAO conference sessions included discussions of many aspects of OCT, including the advance from Zeiss’s Cirrus time-domain system to its Stratus Fourier-domain unit.
Click here to enlarge image

An overview of OCT emphasized the speed difference between the older time-domain systems and the new breed of spectral/Fourier domain units–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.

Exhibit excitement

In the exhibit hall, all the companies you’d expect were on hand to demo OCT: Bioptigen, Carl Zeiss Meditec, Heidelberg Instruments, OPKO, Optopol, Optovue, and Topcon. Canon too rode the OCT wave, demonstrating synergy between Optopol’s system and its retinal camera systems. Most had large displays–in fact, Zeiss’s 100 &time; 100 ft booth was the second largest at the event, where several pharmaceutical companies also dominated. Bioptigen’s smaller display drew a crowd as the company demonstrated its research-targeted unit, the only portable OCT device yet available.

Nidek wasn’t talking about its rumored OCT offering, but if I’m reading the tea leaves correctly, the company will launch it in 2009.

In September Zeiss announced a milestone of 10,000 OCT system placements worldwide, and following AAO, Optovue announced it has 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 one system.

Zeiss’s Stratus was the original time-based OCT system and so the company has dominated the arena; asked how its market share has held up, 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%.

OCT systems aren’t the only Zeiss products to have achieved 10,000 installations: its IOLMaster recently reached the same level. Zeiss’s IOLMaster Advanced Technology Software Version 5 increases the number of patients that can be measured for intraocular lenses, 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.

Product introductions

Zeiss also announced other new and updated products, too. The company noted that the announcements covered the entire spectrum of patient care and support all major ophthalmology segments: cataract/refractive, retina, and glaucoma. Its two new systems are the OPMI Lumera Surgical Microscope and the VISULAS Trion Combi System, which Zeiss says is the world’s first multicolor photocoagulator (it uses yellow, red, and green wavelengths) paired with a photodisruptor for complete retina treatment.

Zeiss also debuted Acri.LISAtoric, “the world’s only multifocal toric MICS intraocular lenses,” at AAO. The Acri.LISAtoric is not yet approved for sale in the U.S.

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 combines YAG and SLT technologies; a powerful dual-port photocoagulator; and a line 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 and 1 W of 670 nm red 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 the treatment Retina Regeneration Therapy using Ellex’s 2RT laser, which uses 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. “For the first time, we can obtain all the therapeutic benefits seen with earlier laser treatments, but without the collateral damage,” said Prof. John Marshall of St. Thomas’ Hospital, London, who led the study. –BG

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