Three emerging technologies, all derived from technical optics, promise important advances in ocular surgery in as little as the next two years.
by Michael Mrochen, PhD, and Luca Sergio
Michael Mrochen, PhD
What has excited me the most over the past few years are three diagnostic advances that should prove highly valuable to surgeons. All three have a core technology taken from technical optics.
Ophthalmology has benefited greatly from such horizontal translation, in which innovation in one field is applied to another. Lasers, for example, were developed for the military and then adapted to ophthalmic use.
When evaluating an emerging technology, I look first at what it offers our patients in terms of better clinical outcomes and safer procedures. Second, I consider is what it brings to surgeons—that is, how it might make the surgeon’s job easier, such as by saving time or reducing error. Finally, I evaluate whether the emerging technology can be supported by a feasible business model.
The first of these three translated technologies, from ClearSight Innovations, aims to improve preoperative measurement of the eye by moving away from regression formulas. The ClearSight device, currently being tested in a large clinical trial, uses Purkinje imaging with optical coherence methods to derive postoperative intraocular lens position. The device has the potential to significantly improve the refractive predictability of cataract surgery through optical ray tracing methods, avoiding the refractive surprises that we have to live with today.
The second technology, from Simultaneous Vision Simulation (SimVis), simulates multifocal presbyopia-correcting solutions. Explaining the concepts of presbyopia and multifocality to patients can be difficult. SimVis is a portable device that provides the patient with a pure simultaneous vision experience in real-life settings. Patients can experience the compromise between increased depth-of-focus (and hence improved near vision) and a reduction in distance visual quality.
The third product, from Avedro, uses Brillouin optical microscopy—which does not cause the mechanical deformation associated with other methods of measurement—to provide more accurate quantitative biomechanical measurements of the cornea and other ocular tissues. Brillouin scattering is a phenomenon that arises from the interaction between incident light and tissue within a defined area. Researchers working with porcine corneas have demonstrated that Brillouin optical microscopy is sensitive enough to detect differences between corneas treated with different cross linking (CXL) protocols. Although more research is needed to establish the clinical role of Brillouin optical microscopy, the goal is to integrate the information it provides with that of corneal topography to design a customized CXL treatment plan for eyes with keratoconus or to perform a refractive CXL treatment.
All three of these diagnostic technologies, which came out of university research, have attracted business partners, including myself. They could all enter the market in the next two to three years. A clinical trial of ClearSight in more than 100 eyes is currently underway. Several studies of Simultaneous Vision Stimulation, the second technology, have already been published in peer-reviewed journals. And Avedro is planning a controlled launch of a commercial device within the next 12 months.
Of course, clinical research is only one step. After an emerging technology has been validated by clinical research, it must still find acceptance within the market. The practicing ophthalmologist must find the technology useful and capable of being integrated into actual practice.
Michael Mrochen, PhD, is founder and CEO of Zurich-based IROC Science to Innovation AG, a leading ophthalmic consulting service with specialized expertise in ophthalmic clinical trials. He is also a member of the medical advisory board of Avedro Inc and a cofounder of Clear Sight Innovations Ltd and SimVis Ltd. On Wednesday May 20th, Dr. Mrochen will speak about lasers and eyeballs in a Pint of Science event in Dublin, Ireland. For more information, visit Pint of Science.