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Sustained growth predicted for
A bright future ahead
Sustained growth predicted for the market at Ophthalmology Futures Forum. Dermot McGrath reports
Abright future with sustained market growth and continued innovation in all domains of ophthalmology – that was the clear message to emerge from the 2019 European Ophthalmology Futures Forum held in Paris, France.
“We are now on our eighth European Forum,” said Keith Barton MD, FRCS, co-chair and co-founder of the Ophthalmology Futures Forum along with Kuldev Singh MD, MPH. “Since we first came up with the idea in the back of a car on the way to ARVO in 2012, Ophthalmology Futures has grown dramatically.
We have had two standalone Retina Forums, one here in this venue last week and three Asian Forums and a few other events in Chinese meetings. The future in the ophthalmic space seems very bright and destined to continue growing,” he said.
Founded in 2012, the Futures Forums are clinician-driven innovation meetings focusing on new technology, entrepreneurial ventures, market access and other aspects of commercialisation in the ophthalmic healthcare sector. They cover all aspects of global innovation in ophthalmic devices, diagnostics and pharmaceuticals by connecting scientists, physicians, regulators, reimbursement specialists, corporate leaders, venture capitalists and other investors who support the advancement of eye care.
KEY ISSUES Delving into key issues of relevance to the field of ophthalmology, the opening debate at the Forum focused on the growing array of solutions for presbyopia. Chaired jointly by Sheraz Daya MD, FRCOphth, Chairman and Medical Director of Centre for Sight, United Kingdom, and Arthur Cummings MD, Consultant Ophthalmic Surgeon and Medical Director, Wellington Eye Clinic, Dublin, Ireland, panellists were asked to discuss the range of solutions they offer to their presbyopic patients.
Gerd Auffarth MD, FEBO, Professor and Chairman of The Department of Ophthalmology, Ruprecht-Karls University of Heidelberg; Director of the IVCRC and The David J Apple International Laboratory of Ocular Pathology at The University-Eye Clinic of Heidelberg,
Germany, said that there was no “one size fits all” approach for presbyopia.
“We offer corneal approaches with inlays or laser as well as a wide varies of intraocular approaches including trifocal, multifocal and accommodative IOLS. We are covering an age spectrum from late 40s to early 60s or mid 60s so we have to apply a range of technologies to account for differences in age, refraction and other variables,” he said.
Aylin Kiliç, Associate Professor, Istanbul Medipol University, Turkey, said that in addition to multifocal IOLs, she has recently been involved in a clinical trial of a novel allograft corneal inlay (Transform, Allotex).
She explained that the inlay is a piece of acellular cornea prepared from eye bank tissue that is sterilised with electron beam radiation and shaped using an excimer laser. It has a refractive add power of +2.5D and is designed to improve near vision by increasing depth of focus and corneal power in the non-dominant eye.
“We have about two years' follow-up with this technique and the results have been amazing, with no cases of clinically relevant haze, corneal opacities or foreign body sensation in that time. The procedure is reversible and it is a very positive about this approach,” she said.
Erik Mertens MD, FEBO, PCEO, Medical Director and Eye Surgeon, Medipolis, Antwerp, Belgium, said that he has switched from corneal approaches such as SupraCor excimer laser and Kamra inlays.
“I had to remove about half of the inlays I was implanting so I decided to stop. The only inlay I use now is the Allotex allograft corneal inlay. For intraocular procedures and refractive lens exchange, I use the multifocal EDOF lens and in this regard we are currently awaiting the results of the multi-centre study of the EVO+ Visian ICL (Staar Surgical),” he said. NARROWING THE OPTIONS Dr Daya noted that while there is a wide range of options available to surgeons for their presbyopic patients, the reality is that surgeons usually offer a simplified choice to keep chair time to a minimum and make life easier for the entire surgical team.
Dr Kiliç agreed and said that in addition to the new allograft inlay, there is still a lot of demand for LASIK monovision, which “works well for a lot of patients but which is far from perfect”.
Dr Auffarth said that while narrowing the options made sense from a practice efficiency perspective, it was not something that could satisfy all patients.
“If we really are focused on one device or one procedure then it is possible from a commercial point of view to train the entire staff to examine and preselect the patients with that procedure in mind, and do about 80% of patients successfully in this way. However, we will have to explore other options for the remaining 20% or you can refer them elsewhere and let somebody else handle it. Even though every doctor would like to be able to offer a single solution, it remains patientbased and they may need different options,” he said.
FORMIDABLE CHALLENGES Plano presbyopic patients pose one of the more formidable challenges for surgeons, said Dr Mertens.
“They usually only use glasses for reading and every procedure that you do they will lose distance vision and often end up dissatisfied. For the rest of my presbyopic patients, I use phakic IOLs a lot and less laser refractive surgery because this approach is more reversible. And in terms of inlays I only use the Allotex allograft corneal inlay which is biocompatible and avoids a lot of the issues with other inlays,” he concluded.
