• Corneal collagen crosslinking. Approved last year after more than a decade of international experience, this procedure offers nonsurgical strengthening of the cornea for keratoconics, and perhaps a way to prevent post-LASIK ectasia. Some ODs are already wondering if this fairly low-risk procedure might one day make its way to optometric practice. Whether as providers or comanagers, ODs will play a key role.
• Dry eye. The success story of 2016 was the launch of Xiidra (lifitegrast, Shire), which is already changing how we practice. New treatments likely in 2017 include TrueTear, a neurostimulus device from Allergan that can activate the trigeminal nerve to trigger tear production (likely all three layers), and Dr. i-Coach, an overlay placed on a mobile device to train patients to blink frequently and properly. It also encourages proper eye elevation ergonomics, illumination and relaxation of the accommodative system.
• Glaucoma therapy. New drugs anticipated include latanoprostene bunod (Vyzulta), a nitric oxide-donating prostaglandin with two outflow pathways that shows improved IOP-lowering capacity. Three new-class therapeutic agents in Phase III trials include the Rho kinase inhibitor netarsudil mesylate 0.02% (Rhopressa), the norepinephrine transporter inhibitor trabodenoson (a highly selective adenosine type 1 receptor agonist) and Roclatan, which combines netarsudil mesylate with latanoprost; in recent clinical trials, it showed more IOP lowering than any drug to date. Watch for these in late 2017 or early 2018.
But 2017 may be the year of minimally invasive glaucoma surgery (MIGS). Recent approvals of the Xen implant from Allergan and Cypass from Alcon will continue to boost awareness of MIGS.
• Drug delivery systems. Expect a wave of innovation here to begin this year. Only about 10% of a topical drug typically penetrates the cornea, and compliance is a major issue for all patients. Both could potentially be addressed with devices we could see in 2017, including Dextenza, a punctal plug that houses dexamethasone. In Phase III trials, it showed a statistically significant improvement over placebo in absence of pain and inflammation after cataract surgery. Glaucoma and dry eye medications are also being studied via this system.
• Cataract surgery innovations. AMO’s Symfony IOL provides good near and intermediate vision along with distance correction, plus a toric option. It has been a great recent addition for patients interested in better post-op vision. Its more forgiving nature has set a high bar.
Alcon’s just-approved AcrySof IQ PanOptix Toric is another new way to correct for near, intermediate and distance vision, plus astigmatism.
A new technology in the final steps of FDA clinical trials may also dramatically alter the landscape in 2017 if approved. The Calhoun Vision light adjustable lens allows surgeons to adjust the final IOL power postsurgically, using an ultraviolet laser to fine-tune the refraction. If the patient has an IOL calculation ‘surprise’ and ends up +1.00 after surgery, they can have the lens altered with the laser to correct it to plano. This technology eliminates the influence of the inherently unpredictable healing response.
• Wearabless and telemedicine. Consumer and professional products are changing our visual experience of the world. Eyeglass-mounted cameras from PogoTec and Snap will capture consumer interest in wearable tech. For surgeons, technologies like TruVision Systems improve ocular surgeries like cataracts and especially retinal surgery by providing 3-D enhanced imaging and the ability to overlay angiography or OCT images for precise manipulation of tissue.
Finally, a group of optometrists (CoolDoctors) have advanced the area of telemedicine for our profession with an impressive platform that will allow for HIPAA-compliant follow-up visits and acquisition of new patients digitally. Keep in mind that these visits are billable in your state of licensure. Expect this trend of remote access to patients to advance in 2017 and beyond.
Financial disclosures for Dr. Karpecki relevant to this article: AMO, Alcon Labs, Allergan, Bausch + Lomb/Valeant, Eyes4Lives, Glaukos and Shire Pharmaceuticals.