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Up Front: Chief Medical Editor's Page | June 2021

Pendulum Swing

The demand for ophthalmologic care is exploding—a ripple effect of the COVID–19 shutdowns. A backlog of patients who avoided appointments during the height of the pandemic are now, with the availability of a vaccine, scheduling the appointments they missed or put off. Many of these patients also have surplus savings now, so they are potentially more apt to invest in their vision than ever before.

Another converging factor is that the premium channel has been around in cataract surgery long enough that news of its benefits is spreading by word of mouth among patients. Offering astigmatism and presbyopia correction alongside cataract surgery has become an expectation and the standard of care. More patients are aware of and asking about premium options before they even get to the office, a trend that is only going to increase as the market grows. Fortunately, industry has responded with new IOL offerings, including the AcrySof IQ Vivity (Alcon) and Tecnis Synergy (Johnson & Johnson Vision). Even new monofocal options are available such as the RayOne EMV (Rayner) and Tecnis Eyhance (Johnson & Johnson Vision) that offer yet another vehicle for increased range of vision through manipulation of spherical aberration.

As IOL options continue to expand, so does the challenge of matching the right technology to the right patient. The trend away from a one-size-fits-all model in cataract surgery toward a highly customized approach will be ongoing in our space. Accommodating this trend involves surgeon training and expertise and increased awareness and competency among technicians, surgery counselors, and even phone operators.

On top of the pent-up demand on the patient side, there’s also a lot happening with industry that had been on hold earlier in the pandemic. Many companies are actively pursuing technological improvements. As OR visualization systems continue to mature, more surgeons are experimenting with heads-up surgery. In addition to the Ngenuity 3D visualization system (Alcon) and Artevo 800 (Carl Zeiss Meditec), a headset visualization system for virtual reality surgery, the Beyeonics One (Beyeonics), is coming to market. All of these technologies aim to improve outcomes and patient care by enhancing the view of the surgical field and allowing surgeons to operate in a more comfortable and ergonomically correct posture.

The MIGS space continues to expand. Two startup companies, ViaLase and ELT Sight, are researching laser treatments for glaucoma. ViaLase is working on a ground-up standalone OCT-guided noninvasive femtosecond laser, and ELT Sight has developed Elios, an intraocular excimer laser probe that can be used either in conjunction with cataract surgery or as a standalone procedure. Elios is already approved and commercially available in Europe. Both devices aim for precise laser augmentation of the trabecular meshwork and collector channels to lower IOP.

There’s also a huge pipeline of topical medications in development for the treatment of presbyopia. Some of the drops are designed as a standalone therapy and others in conjunction with cataract surgery and postoperative treatments to improve range of vision with monofocal and multifocal IOLs depending on the mechanism of action and active ingredients.

We ophthalmologists have been in a defensive position for the past year and a half, trying to keep our heads above water and deal with the pandemic. It seems, however, that the flood gates are opening—both on the demand for surgery and the tools and technologies available to optimize it. Developing a practice that supports the integration of new technologies as they emerge in order to deliver premium outcomes and builds the infrastructure and throughput to deliver premium experiences is one of the biggest challenges facing surgeons in the years to come.

It will be challenging for us to keep up with all of the innovations as we emerge from the pandemic overwhelmed by the increased patient volume it has caused. The growing shortage of qualified staff and technicians exacerbates the challenge and places an additional burden (both physical and mental) on the physician and existing support personnel. This environment lends itself to oversights, missed diagnoses, and medical errors. Needless to say, it’s a critical time in all of our careers, and I know we will rise to the occasion and succeed.

Robert J. Weinstock, MD | Chief Medical Editor

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