12/2/2013. Photochromic contact lenses. Drug dispensing contact lenses. Innovega Inc. ioptik Contact Lens

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1 STMicroelectronics is working with Swiss company Sensimed to develop a contact lens with nano-sensors fabricated in silicon-based MEMS technology which can be used to measure the shape of the human eye and could be used in the early diagnosis of conditions such as glaucoma. 1

2 Photochromic contact lenses Developed by biochemical engineering professor Jin Zhang at the University of Western Ontario in Hamilton, the new technology benefits from hydrogel contact lenses made from extremely small nano-particles. The nano-particles used in these lenses react with glucose molecules found in tears, causing a chemical reaction and subsequently changes in their color 8 Drug dispensing contact lenses Microsoft and the University of Washington are developing an electronic contact lens that can non-invasively monitor and wirelessly report blood sugar levels Innovega Inc. ioptik Contact Lens Standard OLED or LCD Display Panel Video/Audio IC Outer lens sharpens view of normal surroundings (50% of population need corrective lenses) Contact Lens With Embedded Optics Eyeglasses Center lens streams HD/3D Digital Media from eyewear flat-panels or projectors Optical Filter Conditions Display Light 2

3 Copyright /20 is not Vision Optimized! 3

4 RHA Optometrist s Gateway to the RPE FDA approved Health Canada approved European CE Mark obtained ANNIDIS HEALTH SYSTEMS 21 Neural layers Photo receptors RPE Choroid 4

5 Fundus Camera Range OCT/SLO ILM IPL INL ONL OPL ELM OPR RPE Bruch s Choroid PIL NFL The doctor sees all of these images Composite Green Red 5

6 Composite Green Red 6

7 Composite Green Red AMD Composite 7

8 Green Red Point-of-Care Diagnostics VMTS-ERM 8

9 Historical Diagnostic Tests Pt questionnaire Schirmer Test Tear meniscus height Tear break-up NaFl Lissamine Green or Rose Bengal Phenol thread test Interferometry (not practicle in clinical setting) Tear Osmolarity and Dry Eye Study to determine if tear osmolarity was valuable in diagnosing keratoconjunctivitis sicca (KCS) Tear samples were taken from 31 normal eyes and 30 eyes diagnosed with KCS Normal eyes showed an average of 302 +/- 6.3 mosmol/l and KCS eyes showed an average of 343 +/-32.3 mosmol/l Gillbard JP, Farris RL, Santamaria J. Osmolarity of tear microvolumes in keratoconjucntivitis sicca. Archives of Ophthalmology 1978 Apr;96(4): Osmolarity is the gold standard test for Dry Eye Disease 45 years peer reviewed research Osmolarity has been added to definition of Dry Eye Global marker of Dry Eye, indicating a concentrated tear film Osmolarity in the Diagnosis of Dry Eye Disease Clinical Test PPV Osmolarity 87% Schirmers 31% TBUT 25% Staining 31% Meniscus Height 33% Source: DEWS Report, Ocular Surface April 2007 Vol 5 No 2, & Tomlinson A, et. al., IOVS 47(10)

10 Conclusions drawn from osmolarity evaluation Normal subjects exhibit low and stable osmolarity mosm/l equivalent to blood osmolarity, proper homeostasis* Dry Eye subjects exhibit elevated and/or unstable osmolarity Variability is the hallmark of DED ( > 8 mosm/l between eyes) Dry Eye is far more prevalent than previously assumed Many subjects exhibit little or no symptomatology Symptoms alone are insufficient to diagnose Dry Eye Disease Many symptomatic subjects have non-ded cause of ocular irritation (e.g. MFS) icare Tonometer No air No drops No corneal sensation effect THE RED EYE PROTOCOL for conjunctivitis 10

11 All Sjögren s patients are identified and diagnosed There are only a few patients in my practice Nothing can be done for the patients if they are diagnosed Sjögren s Syndrome does not have serious long-term consequences, it is just a nuisance Myth: All Sjögren s patients are identified and diagnosed Current Screening Combined serology sensitivity & specificity is around 40-60% None of the serology test diagnose SS early Misses approximately % cases All serology tests identifies are non-organ specific autoantibodies and could occur in other autoimmune diseases New SS Panel Combined serology sensitivity & specificity is 87% and 82.5% respectively Cumulative specificity of 92.2% for CA6, SP-1, and PSP Approximately 50% of the early & new cases are identified (Ro and La Negative) Picks up additional cases Comprises of both organ/nonorgan specific auto-antibodies PROKERA Class II medical device comprising of CRYOTEK amniotic membrane into a thermoplastic ring set Combines the functionality of a symblepharon ring with the biologic actions of CRYOTEK amniotic membrane to create a unique treatment option for corneal and limbal wound healing Clinical Evidence for PROKERA A safe and effective method to promote healing of the corneal surface with minimal side effects 1 Inhibits abnormal angiogenic processes and inflammation, thus promoting scarless healing 1-7 Stimulates healthy re-epithelialization of the corneal wound without sutures 1,2,4-6,8 Provides pain relief and reduces haze, resulting in improved visual acuity by a mean (SD) of 2.5 (2.6) Snellen lines 2 1. Pachigolla G, et al. Eye Contact Lens. 2009;35: Sheha H, et al. Cornea. 2009;28: Gomes JA, et al. Curr Opin Ophthalmol. 2005;16: Shay E, et al. Cornea. 2010;29: Kheirkhah A, et al. Arch Ophthalmol. 2008;126: Shammas MC, et al. Am J Ophthalmol. 2010;149: Shay E, et al. Invest Ophthalmol Vis Sci. 2011;52: Lazarro DR. Eye Contact Lens. 2010;36:

12 PROKERA Insertion Set patient expectations! Inform the patient they may experience some initial stinging and foreign body sensation Apply topical anesthesia Rinse the PROKERA a with a sterile solution (saline, BSS etc ) Hold the upper eyelid Ask the patient to look down Insert the PROKERA into the superior fornix, preferably using your fingers to hold the ring Slide the PROKERA under the lower eyelid 12

13 Devices Used ALLEGRO Topolyzer ALLEGRETTO WAVE Eye-Q Cassini The Industry s First Color LED Corneal Shape Analyzer Study Device: Laser Notebook + T-CAT Software Cassini LED Technology Red, green and yellow Blue for apex Red LED internal fixation target CE marked FDA cleared 1.McAlinden IOVS 2011; 2. Karabatsas BJO 2013; 3. Pentacam Brochure Specs; 4. Tripoli et al. American Journal of Ophthalmology 1996; 5. Tang et al, Optometry and Vision Science,

14 Cassini - True Corneal Shape Analysis True Aberrometry Cassin s point-to-point measurement principle is not affected by the radial mismatch. True Shape Instantaneous measurement provides motion artifact-free data input. Cassini s instantaneous data capture pre-empts corrective actions, and results in excellent precision, accuracy and true corneal data. True Axis The combination of Cassini s precision and accuracy profile and the sensitivity of the measuring principle to catch radial changes, results in the measurement of the clinically true axis of astigmatism. Common Incidence Vision Threatening Incidence Posterior Capsular Opacification 10-30% Retinal Detachment % Cystoid Macular Edema (transient) 2-10% Cystoid Macular Edema (persistent) 1-2% Vitreous Loss 1-5% IOL Malposition 0.3% Corneal Endothelial Cell Loss 4-10% Need for Corneal Transplant 0.3% Endopthalmitis 0.1% IOL13079SK 14

15 Comparison of Refractive Outcomes of Laser Assisted Refractive Cataract Surgery Vs Conventional Refractive Cataract Surgery with Phacoemulsification Loretta Ng, OD, FAAO, Tyrie Jenkins, MD, Andrew Loc Nguyen, PhD At 1 month post-op ECCE Femtophaco MSE (DS) *p = Uncorrected logmar *p = D D Uncorrected Acuity 1-Month Post-Op ECCE Femtophaco /20 20/25 20/30 20/40 20/50 20/60 ECCE Femtophaco =32 n=30 n More than twice as many patients achieved 20/25 and 20/20 uncorrected vision at 1-month post-op in the femtophaco group as compared to the conventional ECCE group. 15

16 new level of precision higher level of confidence ORA (Optiwave Refractive Analysis) Copyright 2011 WaveTec Vision TM Standard-Of-Care Technology Light Adjustable Intraocular Lens (LAL ) Developed by Calhoun Vision, Inc Photosensitive Silicone Material Precise, Non-Invasive Post Operative Adjustments > 2 Diopter Correction for Myopia, Hyperopia, or Astigmatism Non-Toxic, Biocompatible Foldable 16

17 Foldable 3-piece silicone IOL Blue PMMA modified-c haptics dpt; / mm biconvex optic Overall length 13.0 mm Manufactured in range from 10.0 D to 30.0 D (+17.0 D to D in 0.5 D steps) h h Increased power (a) (b) (c) Photosensitive Polymerized Unpolymerized macromer silicone macromer macromer diffuses to central region Matrix & causes swelling Adjustment profiles: Sphere: ± 2.0 D; Cylinder: -2.0 D Hyperopia Astigmatism Myopia ~14 µm Pre-irradiation interference fringes +2.1 D Add over 1.8 mm zone +3.5 D Add over 2.0 mm 102zone +2.1 D Add over 2.5 mm zone +3.2 D Add over 2.5 mm zone 17

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