‘Haute’ Trends from the OIS@AAO Runway

This Congress Season, improving patient outcomes through innovation is trending...

At OIS@AAO 2019, ophthalmic supermodels strutted their latest technologies down the anterior segment catwalk. From drug delivery devices and new treatments, providing better patient outcomes was the hottest trend at the recent meeting in San Francisco.

PIE and CAKE magazines, fresh from APACRS in Japan and EURETINA and ESCRS in France, were on-site to cover the latest highlights and key insights from some of the biggest ‘fashion houses’ of the industry.

The digital revolution

The rise of smartphones – and the fact that nearly everybody owns one – has paved the way for innovations on in-home monitoring and remote diagnostics. And while we can argue that too much screen time is detrimental, these new technologies can help patients improve or maintain their vision. At PIE and CAKE, we’re forecasting that these – plus the other vision-improving devices modeled during the Digital Showcase at OIS@AAO – will be ‘in vogue’ in no time.

According to Linda Lam, the chief scientific and strategy officer for Ocutrx Vision Technologies (Irvine, CA, USA), ophthalmology has already been transformed by the digital revolution in imaging and AI, and it has the potential to augment telemedicine, personalized healthcare data, home healthcare, disease monitoring, screening, diagnosis, and treatment.

“The future generation includes systems for in-home monitoring of visual acuity, visual field, and intraocular pressure; mobile fundus cameras have the potential to reach ophthalmic telemedicine so we can provide telemedicine in rural areas, and AI systems for diabetic retinopathy and visual field interpretation are really improving the efficiency of screening,” said Ms. Lam. She says current technology includes smartphone vision screening (with a clip-on adapter for retinal imaging) and virtual reality headsets to help magnify or help improve facial recognition.

She said this digitalization will be of particular importance to meet the challenges of rising costs and the changing demographics of an aging population: “This digital-health revolution provides compelling health-value propositions to all stakeholders, including the patients, physicians, payers, and pharma.”

“Technology advancement could lead to controlling these healthcare costs, particularly in our field of ophthalmology,” continued Ms. Lam, adding that providers are using digital healthcare services in an effort to reduce inefficiencies, improve access, reduce cost and increase quality. 

With an annual growth rate of 29% annually for digital healthcare, this is one innovation that is certainly a ‘haute’ priority in the future of ophthalmic screening, diagnostics and treatments – all designed to tackle the rising challenges faced by both patients and healthcare providers.

Like these industry leaders, the team at PIE and CAKE magazines is also on top of ophthalmology’s top trends.

Up-and-coming trends in treatment

Preservative-free topical drops, halting the progression of myopia and targeted drug delivery were but a few of the ‘Haute’ topics sashaying down the OIS@AAO catwalk. Below, we take a sneak peek of some of these innovative treatments . . .

“Preservatives are really important in the bottle, but they’re really problematic on the eye,” said Dr. Vance Thompson. So, what if you could keep the preservatives in the bottle and off the eye? According to Dr. Thompson, this is now possible with TearClear (Orange County, CA, USA) – a start-up developer of a first-of-its-kind, reliable delivery of a preservative-free drug from a multi-dose bottle for glaucoma treatment. “This is a big deal because we know there are 52 million glaucoma prescriptions written every year,” said Dr. Thompson.

“As the drop goes through the hydrogel it is trapped, and what’s delivered to the eye is a totally preservative-free drop. The patient will be happy... they’re not going to get the red eye and they’re compliant.”

Targeted delivery is the name of the game at EyeNovia (New York, USA). According to Sean Ianchulev, MD, CEO, chief medical officer and director, the company is building one of the most robust pipelines in ophthalmology in micro-dosing targeting delivery technology. With a focus on serving unmet needs, he said one of their biggest programs is a MicroPine for back-of-the-eye progressive myopia: “This is exciting pharmaceutical approach to slow down the progression of the disease,” said Dr. Ianchulev, adding that they also have MicroProst for glaucoma patients who struggle to administer drops, and Microstat, which eliminates 90% of preservative exposure.

“It’s time to move on – we need to deliver micro-droplets to the ocular surface that go directly to the cornea, not to the conjunctivitis. This eliminates overdose, and we found that 90% of patients were able to administer them successfully,” he explained adding that they are also working on a spray that can deliver 3-4 hours of spectacle independence for presbyopia patients.

Mark Blumenkranz, MD, CEO, chairman and co-founder of Kendalion says that about 20 million people use eye drops in the U.S. each year – and for the very youngest, or those that are older with impairments, it’s a real struggle. Therefore, Kendalion is building AcuStream, a sophisticated platform with a number of features like micro-dosing as a gentle stream (not a mist), the ability to aim, the ability to dispense all viscosities of drugs, the potential to be preservative-free and to multi-dose. 

“The drug application is incredibly comfortable,” said Dr. Blumenkranz. “On top of everything else, we have an app that tracks utilization, provides reminders and tracks compliance.”

Moving away from eyedrops and delivery systems, Rx Sight (Aliso Viejo, CA, USA) showcased its latest innovation: the Light Adjustable Lens or LAL. According to Ron Kurtz, MD, president and CEO, the Rx Sight LAL is now entering commercial clinical practice. “This is the first IOL that allows the doctor and patient to collaboratively customize vision after cataract surgery,” said Dr. Kurtz.

“This new capability has the potential to simplify the premium IOL preoperative messaging and decision-making process, deliver better uncorrected vision and vision quality and deliver a range of astigmatism and presbyopia corrections with a single lens solution.”

Additionally, visual results compare favorably to the latest trifocal design and the process can be repeated multiple times until the patient is satisfied. 

At SightGlass Vision (Palo Alto, CA, USA), myopia is not treated as a benign condition – in fact, the company’s mission is to develop innovative products to stop myopia. John Rappon, chief medical officer, said that as the severity of myopia increases, there’s an increase in macular myopathy – and it’s necessary to intervene early to change the course of the disease to reduce the risk of ocular comorbidities.

Their latest innovation works by controlling retinal contrast: “We believe that it’s high retinal contrast that causes myopia to increase,” said Mr. Rappon. Therefore, unlike traditional interventions, these lenses are designed to lower contrast in a focus-independent manner, while still providing excellent visual acuity.

According to CEO Nathan Ferrera of EyeYon Medical (Nes Ziona, Israel) believes that its time to eliminate the need for human tissue and create a new type of synthetic cornea. “We’ve started to focus on cornea edema because there is no cure other than the use of human tissue.

Even today, the only way to cure it is with the use of human tissues – and 13 million patients waiting for corneas. For every 70 patients waiting for corneas, only 1 is available,” said Mr. Ferrera. Called EndoArt, the product is currently in long-term human trial follow-up, once this technology is available, he says it’s a simple procedure and it’s available to anyone here anywhere – plus there are no disease transfers and no side effects.

At EyeTronic, President and CEO Monty Montoya says their target indication is glaucoma. “Current treatment is focused on treating IOP and while it’s necessary, it’s found to not be sufficient when treating normal-tension glaucoma patients,” he said, explaining that specifically, the optic nerve should be targeted – and that means reactivating the nerve cells with an electrical current.

Details from 12-month data revealed that disease progression was halted in 73% of patients. “We also have a functional increase – vision can happen again. Finally, we also see the degenerative nerve fibers are growing again, so there’s a structural improvement too,” he said.

One thing is certain, these innovations all sound like #hautetrends to us.

At PIE and CAKE magazines, we like to blur the lines between fashion and ophthalmology. . .

Curtain call with industry leaders

Digitalization isn’t a future trend – it’s here now – and it’s certain to impact the way both patients and physicians operate. To address its opportunities and impacts, several healthcare leaders offered their insight during the Healthcare Leaders’ Perspectives: Opportunities and Challenges discussion, moderated by James Mazzo, the global president of ophthalmic devices for Carl Zeiss Meditec (Jena, Germany). Mr. Mazzo asked the panel to discuss not what’s happening now – but what’s happening in the next three to five years...

“I think the digital revolution is already here – yes it will change the way doctors practice,” said Michael Kaschke, PhD, president and CEO, ZEISS Group, adding that the fundamental job of a doctor interfacing with a patient will not change, rather how this interface is going to happen will change.

“First, digitalization will make the healthcare industry more efficient – there’s no way around it. And the second, essentially by higher patient education, the ability of every person to interface with a health professional and to get a better understanding of his or her health – these are basically the two effects that will change.”

Regarding digitalization, Peter McDonnell, MD, William Holland Wilmer Professor & Director, John Hopkins School of Medicine, Wilmer Eye Institute, said that “our belief is that if it’s the right thing for the patient, if it’s a good thing for the patient, then it’s a good thing. Definitely, it’s a learning process, trying to do the right thing with encryption and protecting patient data to help ensure it won’t get misused. But we’ve got to develop these protocols rapidly – particularly for the younger patients who have an expectation when it comes to responsiveness.”

He elaborated further on one key demographic: “Younger patients are connected, they expect to be able to send us an email, they want to schedule without talking to a person, and they don’t want to hear that the doctor doesn’t have an opening for the next six months. They want to be part of the process with the doctor, they don’t just want to hear the doctor talk. So hopefully, it’s a great opportunity for the young doctors to embrace this new way of doing business,” he said.

According to Ashley McEvoy, EVP, worldwide chairman, medical devices at Johnson & Johnson (New Brunswick, NJ, USA), when there’s high consumer engagement, there seems to be really good disruption of innovation – with lower engagement it’s slower. “Technology can be our friend to say ‘get more engaged in the lifetime value of your eyes’,” she explained.

“Technology can enable more of that connective experience, and we’re in the early days and I think that technology can enable a transformation in ophthalmology... things like enabling better telemedicine, that’s a really good thing for patients... it’s not a replacement but rather complementary.”

Meanwhile, David Pyott, the former chairman and CEO, Allergan (Dublin, Ireland), provided some examples of how digitalization can improve the current healthcare system. “The big idea is what I call stratification of care,” he said. “Imagine a scenario of someone who’s been in the ICU and they get discharged and sent home. That patient at home with those monitors can be monitored by a machine and filter out what needs to be looked at by a healthcare professional.” Certainly, this saves valuable time, money and effort for both patient and doctor.

So, there you have it! Certainly, the innovations seen at OIS@AAO will help style the future of treatment and patient outcomes in ophthalmology . . . and we’re looking forward to seeing more of these trending technologies in the near future.