CAKE & PIE POST (52nd RANZCO 2022 Edition) - Issue 3 by Media MICE

ISSUE

03 | 01 | 22

HIGHLIGHTS Stars and Snow 06 Seeing How to diagnose and manage neuro-ophthalmic conditions

Potatoes! 07 Hot Experts tackle clinical controversies at RANZCO 2022

Bionic Eye to Gene 08 From Therapy Is futuristic technology the way forward in the fight against retinal dystrophy?

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Silver Lining Amid threats of a new Cold War in Europe, Day 3 of RANZCO 2022 delivers positive news for our industry by Tan Sher Lynn

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Gloria D. Gamat Chief Editor Editors

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n the midst of escalating conflicts between Russia and Ukraine — and we can’t help but feel useless reading the news, hoping for a more positive turn of events in the coming days — we entered Day 3 of the 52nd Annual Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists (RANZCO Brisbane 2022), feeling a little bit more sanguine about our future. With genetic testing and big data at the forefront, the ophthalmology industry is up to a great start this year, as RANZCO 2022 laid out exciting new discoveries in the field.

The role of big data in neuroophthalmic adverse events Suppression of T cell activation by the programmed death molecule-1 (PD-1) and/or cytotoxic T-lymphocyte antigen-4 (CTLA-4) is considered one of the major escape mechanisms of cancer cells. Immune checkpoint inhibitor (ICI) therapy inhibits these molecules, thereby increasing immune response to treat cancer. However, this Cont. on Page 3 >>

01 March 2022 | Issue #3

An innovative vision for ophthalmology begins with using our ears At Roche, we believe in order to transform vision outcomes in Australia, our innovation must extend beyond the science that underpins our novel medicines and drug delivery solutions. Fundamental to our approach is personalised healthcare, harnessing digital solutions and artificial intelligence to improve diagnosis, identify biomarkers, enhance prevention and guide treatment. Most importantly, we understand that our long-term commitment to ophthalmology has to start with listening to your needs today, to co-create together, for better outcomes tomorrow. In order to keep you informed, we need your contact information and consent. Scan or click on the QR code to access our online consent form. Roche Products Pty Limited, ABN 70 000 132 865, Level 8, 30-34 Hickson Road, Sydney NSW 2000. Medical Information: www.medinfo.roche.com/australia or 1800 233 950. EMVOPH0012 M-AU-00001382 PreparedFeb22

Scan to keep updated on our innovative products, services and events

CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

>> Cont. from Page 1

therapy is thought to create autoimmune consequences, which can affect the eye and central nervous system. Dr. Lynn Gordon from the University of California, Los Angeles, USA, shared her findings on neuro-ophthalmic complications after ICI therapy for cancer during a lecture in neuro-ophthalmology. “After a decade of ICI therapy, there have been high rates of autoimmune toxicity involving nearly any organ and system,” opened Dr. Gordon. “In terms of ocular and neuro-immune-related adverse events, uveitis, dry eye and ocular myasthenia have been reported in the US Food and Drug Administration Adverse Event Reporting System (FAERS). Other reports documented optic nerve involvement, myasthenia gravis, neuropathy and myopathy,” she added. Her team studied the ocular-immunerelated adverse events (OirAEs) due to ICI using both case series and big data. From surveys distributed to neuroophthalmologists through the NANOS listserve and to uveitis specialists through the American Uveitis Society listserv, they found that the mean time between the start of checkpoint blockade inhibition and the onset of uveitis was about two months. And nearly all OirAEs occurred within six months of therapy onset. None of these patients had a prior history of uveitis. Even though the case series provides insights about specific disease sequelae, they did not help the researchers understand

the incidence or prevalence of complications following ICI therapy. They decided to use big data from the IRIS database developed by the American Academy of Ophthalmology, and the Kaiser Permanent Medical Record system, to determine the incidence of OirAEs in patients on ICI. These data found that cancer patients have a higher prevalence of uveitis and neuro-ophthalmic disease, even without the use of ICI. “Overall, the one-year incidence of uveitis or neuro-ophthalmic diagnoses was 1.2% and 1.3%, respectively, for melanoma patients, and 0.2% and 1.4% for non-melanoma patients on ICI therapy. All patients on CTLA-4, PD-1 or combinatorial CTLA-4/PD-1 therapy should be cautioned about the signs and symptoms of uveitis or neuro-ophthalmic adverse events. And patients with a prior history of uveitis or neuro-ophthalmic diagnoses should receive regular ophthalmic evaluations while on any ICI therapy,” Dr. Gordon suggested.

Genetic testing in retinal dystrophies Thanks to the recent access to genetic testing, the genotype-phenotype correlation picture is evolving and new discoveries are being made. Dr. Anita Agarwal from San Francisco, USA, noted that in the last five to six years, large panel testing (of more than 250 genes) has been made available. Today, some of the methods used to confirm a gene defect that contributes to disease include mutataster, an in-silico tool to predict mutation and disease; polyphen (polymorphism phenotyping), a software tool that predicts the impact of an amino acid substitution on the structure and function of a protein; and SIFT (sorting intolerant from tolerant), a program that uses homologous sequences to predict tolerant versus intolerant sequences. “We found that the same genetic mutation can cause variable phenotypic

manifestations. Phenotypes can vary even within families. For example, mutation of the peripherin/RDS (PRPH2) gene can cause discordance and concordance within the same family,” she explained. “And sometimes when we get a genetic result, we get a surprise diagnosis. Other times, there are patients with autosomal recessive diseases with one detected mutation and you don’t have any answers,” she added. Dr. Agarwal shared a case of an uncommon presentation of genetic eye disease. A 53-year-old man from Argentina had progressive nyctalopia over the past six years, decreased central vision for one year, and was diagnosed with dry age-related macular degeneration and retinitis pigmentosa (RP). Fluorescence angiogram revealed transmission defects. Electroretinogram (ERG) showed reduced cone and rod function, but they were not flat. The patient’s mother, maternal grandmother and cousin were also similarly affected. The clinical diagnosis made at that time was possibly late-onset retinal macular degeneration (LORMD) or extensive macular atrophy with pseudo drusen (EMAPD). However, surprisingly, genetic testing results came back showing that he had TIMP3 mutation. “Even though it was considered a variant of uncertain significance, the fact that he had a large physico-chemical difference between serine and cysteine – ‘a gain of cysteine’– which is considered a radical substitution for TIMP3 mutation, is likely pathogenic. So, this is a case of Sorsby fundus dystrophy with non-exudative macular degeneration,” she said. Dr. Agarwal noted that with the availability of genetic testing and a better understanding of diseases, more questions will be answered. “We don’t have an answer for those who have a phenotype, but genetic testing returns with a heterozygous result of a recessive disorder. Is there a mutation that has not been discovered? Are those hypomorphic mutations? Or does epigenetics play a role? Are there environmental or other factors involved? There are more discoveries on the horizon and certainly a lot more to learn about genotypephenotype correlation in diseases,” she concluded.

01 March 2022 | Issue #3

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CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

The Right Tool for the Right Job by Brooke Herron

erforming surgery without instruments is like building a house without tools: It’s just not done. And when it comes to something as delicate as ocular surgery, only the finest instruments will do. Thankfully, today’s ophthalmic surgeon has a veritable arsenal of instruments to choose from — but it’s also this wide variety that can make choosing the best instrument difficult. Indeed, any number of surgical instruments can be viewed by attendees visiting the virtual exhibition at the RANZCO 52nd Annual Scientific Congress. So, to help narrow down the field — and make one decision easier — we’ve selected a few specific products from Pinnacle 360™ to highlight here.

Why choose Pinnacle 360™ instruments? Developed to improve the ease and efficiency of surgical maneuvers, the Pinnacle 360™ portfolio includes forceps, scissors, and specialty devices for foreign-body extraction and procedures on myopic patients. A key feature of these instruments lies in their design: Reimagined as a natural extension of the human hand, their 360-degree actuating mechanism works in tandem with the fingers’ subtle movements. This, combined with the patented fine-wire process that creates micro-serrated edges for traction and securely engages sutures — as well as ergonomic design for maneuverability — all contribute to a smoother surgical experience. Plus, many of the instruments employ a glare-reducing finish to improve visualization — and although they are fully disposable, these instruments are made with reusable quality. Let’s take a closer look at a selection of these instruments now…

Scleral fixation forceps The Synergetics® Pinnacle 360™ 25-gauge scleral fixation forceps were developed at the suggestion of Dr. Daniel Adelberg, an ophthalmologist from Arizona, USA, to fill a significant unmet need in his operating room: The placement of scleral-sutured posterior chamber IOLs for patients without capsular support. Without capsular support, these patients can present a challenging situation for the surgeon. So, with input from Dr. Adelberg, the scleral fixation forceps were created to improve both ease and efficiency of surgical maneuvers in the anterior segment and vitreous. The instrument, which can be considered in any anterior chamber technique requiring forceps, can facilitate angle of entry, hand positioning and wound distortion. The short, curved shaft enables access from the pars plana — while allowing for a more precise hand position and less wrist extension. Meanwhile, its serrated grasping platform engages sutures without shredding them. Dr. Adelberg has said that the scleral fixation forceps have allowed him to refine the technique necessary to execute challenging IOL fixation procedures. Meanwhile, the combined features have facilitated greater safety, precision, control and efficiency — resulting in shorter operations and improved outcomes.

Reddy end-grasping forceps A multifunctional instrument, the Reddy End-Grasping forceps help facilitate precise internal limiting membrane (ILM) and epiretinal membrane (ERM) peeling. This is facilitated by the forceps’ tapered tip (for a more precise grasp) and its long, micro-serrated grasping platform (for ease during ERM/ILM peeling). In fact,

it’s by introducing Microserrations™ to all external surfaces of the distal tip that assists in edge identification and initiation of membrane peels. The Reddy End-Grasping forceps are available in 23- and 25-gauges.

Myopic forceps Last, but not least, are the myopic forceps from Pinnacle 360™. Compared with standard forceps (at 32 mm), the myopic forceps from Pinnacle 360™ provide surgeons with an additional 5 mm of working length for myopic patients (at 37 mm). Two versions are available: the Fine Tip Eckardt forceps and the Microserrated™ Tewari Omnicep forceps — both of which are available in 23- or 25-gauges. And of course, these forceps employ all the advantages of Pinnacle 360™ instruments for an improved surgical experience. To learn more, visit the Bausch + Lomb virtual booth at RANZCO 2022!

01 March 2022 | Issue #3

Seeing Stars and Snow How to diagnose and manage neuro-ophthalmic conditions by Hazlin Hassan

hat do you do when a patient starts seeing stars, stones… and snow?

Sometimes in neuro-ophthalmology, it is the patient who is not quite sure what they are seeing. Other times, it is the doctor.

Heads up: This could be serious

“Given that the visual system takes up about 50% of all of the brain circuitry, therefore, it’s a strong likelihood that a diffuse brain injury will affect those visual pathways. And in particular, the optic nerve in the brainstem, which controls the eye movements, is vulnerable to injuries from that force,” Assoc. Prof. Fraser explained. Research is expanding on the diagnosis and management of acute concussion, post-concussion syndrome and chronic traumatic encephalopathy.

Assoc. Prof. Fraser shared the case of a 19-year-old patient with a history of migraine who sees constant static or snow with movement across his vision. He struggles to drive at night due to lights trailing behind cars and also reports high-pitched tinnitus. “Visual snow is a disorder of visual processing with cortical neuronal excitability being shown in the visual pathways with a perception of otherwise subthreshold stimuli, abnormal contrast and brightness processing, as well as abnormalities in metabolism being seen on PET scan imaging,” she explained.

In a Council Lecture yesterday at the RANZCO 52nd Annual Scientific Congress, Assoc. Prof. Clare Fraser from the Save Sight Institute of the University of Sydney, Australia, explored recent advances in three areas of neuro-ophthalmology from her own research.

A concussion is often colloquially referred to as “seeing stars” after a head injury. The visual pathways make up 30% to 50% of the brain substance, and therefore a diffuse brain injury like a concussion will often result in visual symptoms.

phenomenon that now has its own set of diagnostic criteria. While not being dangerous or progressive, it can cause very disabling symptoms for the patient.

Optic disc drusen are calcified areas in front of the lamina cribrosa within the disc substance. Drusen, which is also the German word for a geode or stone, can cause difficulty for the ophthalmologist who needs to decide if the patient has papilloedema or a true disc swelling. New diagnostic guidelines have been published, and there is increasing research into the nature of disc drusen — how they progress and the risks to a patient’s vision.

Visual snow syndrome: It’s a thing Finally, visual snow syndrome is an increasingly-recognized visual

“So, for those patients seeing snow, visual snow does have diagnostic criteria and is a true biological phenomenon. That perception is altered with tinted lenses affecting the balance of cranial cellular inputs. We have shown that the thalamic cortical pathway changes are measurable, and this is what we think is going to lead us to further potential future therapies,” Assoc. Prof. Fraser shared. Potential therapy includes transcranial magnetic stimulation and neurofeedback approaches. “Patients can be reassured that they will not go blind or become demented,” she noted. While no drug has been proven to benefit patients, any component of migraine, anxiety or depression should be treated. New research is providing insights into the neurological substrate of this phenomenon and will hopefully lead to better treatment options.

CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

Hot Potatoes! Experts tackle clinical controversies at RANZCO 2022 by Joanna Lee

n ophthalmology — or any industry for that matter — debates and clashes of different opinions often arise with every new treatment or development. This was evident during Day 3 of the 52nd Annual Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists (RANZCO Brisbane 2022), where experts from different subspecialties voiced their perspectives regarding topics close to the heart of their practice.

Vision loss from hyaluronic acid Are ophthalmologists aware of this? Apparently, vision loss from hyaluronic acid (HA) filler injections can occur with treatment to any location on the face due to the rich supply of vascular anastomoses that connect to the ophthalmic artery. Dr. Liz Insull, clinical lead at New Zealand’s Hawke’s Bay Hospital, explored various solutions to mitigate this issue. Although retrobulbar hyaluronidase seems to help, its efficacy remains controversial and there are no gold standards yet to treat this condition. Evidence suggests there’s a 90-minute window before vision loss occurs, so every attempt to dissolve the filler and vision loss must be made quickly.

Myopia control: Where are we in the issue? By the year 2050, it is expected that 1 billion people will have myopia. Pediatric

ophthalmologist and Assoc. Prof. James Elder from the University of Melbourne looked at the treatment of myopia from all possible angles. Do we treat myopia from childhood onwards to prevent progression to myopic macular degeneration? He also thinks biological data is difficult to compare at the moment, although increased sunlight exposure in childhood seems a possible answer — with the controversy being how to balance this with skin cancer concerns. He proposed 0.01% atropine treatment, perhaps combined with peripheral defocus lenses, or with orthokeratology.

Ophthalmology practice amid COVID-19 Conundrums have been arising while navigating the minefield of clinical scenarios amid COVID-19, some involving patients’ concerns and treatment contraindications in the light of vaccinations. Assoc. Prof. Lyndell Lim at the University of Melbourne brought up her patients’ cases where some have uveitis, an autoimmune condition, and her response when some had sought exemptions or when their uveitis had recurred with severity after vaccination. She highlighted, though, that ophthalmologists should be aware of drugs (like prednisolone) that would interfere with vaccination and when to resume treatment along with other drugs

to consider for vaccinated patients who are immunosuppressed.

Uveal melanoma surgery Does uveal melanoma surgery improve survival? Ocular oncologist and anatomical pathologist Dr. Daniel McKay said it is preventing some metastatic disease in some patients — although survival benefit can’t be established for sure. The surgery is useful for arresting its progression towards the fovea and optic nerve and avoiding an eventual painful and blind eye. Also, common findings are showing that progressive mutations of individual tumors give theoretical reasons to inactivate or remove the tumor. Several studies show that the best opportunity to save lives is to treat small tumors.

PRP vs. anti-VEGF injections in PDR management Pan-retinal photocoagulation (PRP) laser has been in use since the 1950s and had become the gold standard for treatment since the 1970s when the diabetic retinopathy study (DRS) indicated that PRP more than halves the risk of severe vision loss in the disease. This changed in 2015 after the publication of the DRCR.net Protocol S paper. So, is anti-vascular endothelial growth factor (anti-VEGF) therapy the new gold standard? Assoc. Prof. Anthony Kwan analyzed the outcome of several landmark studies. Anti-VEGF therapy appears to be a safe and effective alternative to PRP laser in the treatment of proliferative diabetic retinopathy (PDR) — with or without diabetic macular edema. It offers less vision loss and less visual field loss, but the advantage is reduced by year five. However, anti-VEGF presents as a significant burden due to the number of visits required, apart from the costs. Assoc. Prof. Kwan suggested that the best treatment would be an individualized patient plan. Meanwhile, further studies are needed to evaluate the long-term outcome and combination therapy, such as anti-VEGF followed by PRP.

01 March 2022 | Issue #3

From Bionic Eye to Gene Therapy Is futuristic technology the way forward in the fight against retinal dystrophy? by Hazlin Hassan

She noted that signs and symptoms could be determined by observing how the patient behaves in different lighting conditions, whether they are lightsensitive or unhappy when the lights are turned off at night.

ow do you beat something that is not only degenerative but also possesses the superpowers of clinical and genetic heterogeneity? Retinal dystrophies (RDs) are the leading cause of hereditary blindness with the following common presentations: color blindness or night blindness, peripheral vision abnormalities, and subsequent progression to complete blindness in progressive conditions. In a special session yesterday at the RANZCO 52nd Annual Scientific Congress, experts shared tips on how to diagnose and treat this group of degenerative and hereditary retinal disorders.

Make a thorough genetic diagnosis To date, some 280 genes are known to be associated with different phenotypes of RDs. Mutations within the same gene have been associated with different phenotypes, even within different individuals of the same family According to Assoc. Prof. Andrea Vincent from the University of Auckland, New Zealand, clinical phenotyping in inherited retinal disease can be used to guide clinicians in making a genetic diagnosis.

“It starts with history. Find commonality — a clinical examination — obviously not only of the patient, but they usually have one or two family members in the room, and examine them. Then we have a host of tools that we can use, optical coherence tomography (OCT), widefield imaging and fundus autofluorescence, my favorite mode ever,” shared Assoc. Prof. Vincent. “Once we have every little slice (of information), we can try and put them together to come up with a diagnosis,” she added.

“The genetics of the inherited disease is complex, but by really honing in on our clinical phenotyping and getting a good pedigree, clinical phenotyping will inform genotyping and subsequently help us coordinate in genetic environments,” she said.

Embrace the challenges and limitations of gene therapy While ophthalmology is at the forefront of the fast-moving field of gene therapy, limitations and challenges remain. “The treatments are very expensive, and they’re limited to a relatively small number of our patients at this stage,” said Dr. Thomas Edwards, vitreoretinal

CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

surgeon and head of Retinal Gene Therapy Research at the Centre for Eye Research Australia, who presented the potential of gene therapy for inherited retinal disease. “With that said, it’s a very fastpaced field and the Food and Drug Administration (FDA) is predicting 10 to 20 new gene therapies approved per year by 2025,” he added. Financing in the regenerative medicine sector is also seeing an exponential rise — from US$6 billion in 2019 up to US$20 billion in 2020. The range of potential objectives is to restore the function of a gene, silence the aberrant function of a gene, induce a new function or manipulate a known disease pathway, or induce a neuroprotective effect. Gene therapy strategies include gene replacement or augmentation, genome editing, optogenetics and RNA modulation. In gene replacement or augmentation, a working copy of the gene is delivered to affected cells. “Using CRISPR/Cas9related techniques to edit the patient’s own DNA is a good strategy for when you’ve got, for example, a missense mutation, which causes a dominantnegative or toxic kind of function, mutation,” Dr. Edwards explained. In a clinical trial phase for LCA10 (CEP290), Leber congenital amaurosis type 10 (LCA10), an autosomal recessive disorder caused by a mutation that causes an exon to form in an area of intronic DNA that should not be there, which causes premature truncation of the gene. Optogenetics is for advanced disease, where perhaps the patient has lost all of their photoreceptors. There are clinical trials ongoing for these optogenetics approaches, with their own challenges. However, for someone who may have next to no vision, this new technology may prove to be exciting. Another approach is using RNA and small RNA molecules to knock down

disease-causing messenger RNAs, alter their pattern of splicing or block translation. “Inherited retinal diseases generally progress very slowly. So the challenge now is really to develop novel outcome measures that can control a treatment effect early, early on,” Dr. Edwards said.

Bionic eye and other innovations to the rescue! Assoc. Prof. Penny Allen, vitreoretinal surgeon and head of the Vitreoretinal Unit at The Royal Victorian Eye and Ear Hospital in Australia, provided updates on a futuristic bionic eye that can partially restore sight loss due to retinitis pigmentosa (RP), an umbrella term for many inherited retinal diseases. A bionic eye is a revolutionary device that can use electrical or light energy to stimulate visual impulses in patients who are otherwise severely visually impaired. It comprises an imager or camera that converts light into an electrical signal, electronics to process the image and generate electrical stimulus pulses, and microelectrodes to stimulate the retina. “Despite the absence of photoreceptors, there is a largely intact neural retina. It is the presence of this intact neural retina that can be stimulated by a device within the eye and offers the opportunity for vision,” said Assoc. Prof. Allen, who is also the head of the Bionic Eye Research team at the Centre for Eye Research Australia. Previously, there were three commerciallyavailable devices, but all three have now been suspended.

A six-month safety and efficacy trial of the Intelligent Reti Implant System II Device in RP saw 10 participants successfully implanted. There were six serious adverse events in four patients, including leg phlebitis, hypotony and persistent ocular pain. All results were better with the device on compared to the device off. The limitations of all devices include low resolution, surgical difficulty and complications which vary between the approaches. The proximity to target neurons also varies. Retinal prostheses do offer the possibility of navigational and object localization for profoundly blind patients. However, image fading is a real issue, and multidisciplinary teams are required to solve the issues associated with these devices. There are also other cortical devices with the aim of treating patients with visual loss due to other causes than retinal dystrophy. Second Sight’s Orion Visual Cortical Prosthesis System (Orion), an implanted cortical stimulation device, is intended to provide useful artificial vision to individuals who are blind due to a wide range of causes, including glaucoma, diabetic retinopathy, optic nerve injury or disease and eye injury. It aims to convert images captured by a miniature video camera mounted on glasses into a series of small electrical pulses. A six-subject early feasibility study of the Orion is currently underway, with the first patient implanted in 2018. There are no published results as of yet.

01 March 2022 | Issue #3

TECNIS Eyhance Toric available II soon

TECNIS Eyhance™ IOL • Revolutionary performance that deﬁes monofocal enhanced intermediate vision.1 • Outperforms in low-light conditions, increasing conﬁdence in expected outcomes. 2

with TECNIS SIMPLICITY™ Delivery System

Eyhance Toric II IOL TM

• Lock-in visual performance with rotational stability.3

Enhance vision. Exceed expectations. References: 1. Data on File, Johnson & Johnson Surgical Vision, Inc. Sep 2018. DOF2018CT4015. 2. Data on File, Johnson & Johnson Surgical Vision, Inc. 2018. DOF2018OTH4004. 3. DOF2019OTH4015 - Study NXGT-103-MER3 - Proof of Concept Study for Next-Generation IOL Models MER003 and MER004. Aug. 28, 2019. For healthcare professionals only. Please read the Directions for Use for Important Safety Information and consult our specialists if you have any questions. © Johnson & Johnson Surgical Vision, Inc. 2022 AMO Australia Pty. Ltd 507 Mount Wellington Hwy, Mount Wellington, Auckland 1060, New Zealand. Phone: 0800 266 700. PP2022CT4110

CAKE and PIE magazines’ Daily Congress News on the Anterior and Posterior Segments

Get More from IOLs Enhance outcomes for patients and surgeons with Eyhance by Brooke Herron

with astigmatism correction. Surgeons will appreciate that the TECNIS Eyhance Toric IOLs are specifically engineered for rotational stability. This includes new squared and frosted haptics, offering more surface texture and friction between the lens haptics and the capsular bag to provide resistance to rotation. A recent two-part study by Tataku et al.3 looked into the unfolding properties and rotational stability of the TECNIS Eyhance Toric II IOL as compared with its previous generation (TECNIS Toric I). The TECNIS Eyhance Toric II outperformed in every category. According to the researchers: • Time from IOL injection to unfolding was significantly shorter thanks to earlier separation of the haptics from the optics;

oday, surgeons will find no shortage of intraocular lenses (IOLs) to choose from. Each has its own benefits and drawbacks, and a common comparison lies in the quality of vision delivered. To provide the highest quality of vision to patients, including those with astigmatism, selecting the right IOL is critical to outcomes. To help simplify this decision, surgeons need an IOL they can rely on — like the TECNIS® Eyhance™ family of monofocal IOLs from Johnson & Johnson Vision (Santa Ana, California, USA). Designed with the highest quality materials, the TECNIS Eyhance IOLs are backed by realworld experience and data — and most importantly, happy patients.

See more with a modern-day monofocal IOL… To deliver what surgeons and patients want more of — enhanced intermediate vision, excellent contrast vision, and high visual performance even in low light — the TECNIS Eyhance IOL was developed to revolutionize performance. Defying monofocal convention, it achieves enhanced intermediate vision, while distance vision and rates of photic phenomena remain similar to the TECNIS monofocal 1-piece IOL. Improved visual outcomes come as a

result of the IOL’s higherorder aspheric surface, its continuous power changes from the periphery to lens’ center, and its reduction of spherical aberration to nearly zero. But most importantly, patients implanted with the TECNIS Eyhance are happy: Nearly 80% of them did not need spectacles for intermediate distance1 — and 100% had no or some difficulty with seeing to participate in their normal activities and hobbies.2 This empowers patients to not only regain their quality of life, but their confidence as well. Plus, TECNIS Eyhance IOLs also come with the preloaded Simplicity™ Delivery System, adding to the overall safety and efficiency of the procedure. Luckily, it won’t be long before all cataract surgeons in the RANZCO region have access to the TECNIS Eyhance IOL (with the TECNIS Simplicity™ Delivery System): The IOL is currently available in New Zealand and is expected to be available in Australia from April 2022.

…engineered for rotational stability. With all the benefits of the non-toric version, the TECNIS Eyhance Toric II IOL allows surgeons to provide an immediate improvement in functional vision along

• Rotational stability was significantly better (i.e., smaller residual manifest astigmatism, less amount of axis misalignment from the intended axis, lower incidence of misalignment, and less degree of prediction errors); • And postoperative uncorrected distance visual acuity tended to be better. After comparing the surgical outcomes of the two toric IOLs, they concluded that the “TECNIS Toric II IOL with the frosted haptics showed significantly better rotational stability than its predecessor, probably due to faster unfolding and increased friction with the capsular bag.” Cataract surgeons in New Zealand can try the TECNIS Eyhance Toric II Simplicity IOL from March 2022; those in Australia will have to wait a bit longer, with availability to follow later in the year.

REFERENCES 1.

Mencucci R, Cennamo M, Venturi D, Vignapiano R, Favuzza E. Visual outcome, optical quality, and patients’ satisfaction with a new monofocal intraocular lens, enhanced for intermediate vision: preliminary results. J Cataract Refract Surg. 2020;46(3):378-387.

Clinical investigation of TECNIS Eyhance IOL, Model ICB00. 6-Month Clinical Study. September. [Johnson & Johnson internal data.]

Takaku R, Nakano S, Iida M, Oshika T. Influence of frosted haptics on rotational stability of toric intraocular lenses. Sci Rep. 2021;11:15099.

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