Article in Cataract & Refractive Surgery TODAY
Reading through the array of contributions in this month’s predictions issue has been interesting. Experts in six areas of ophthalmology—laser-assisted cataract surgery, IOL technologies, refractive surgery and presbyopia correction, corneal collagen crosslinking, retina, and glaucoma—have shared their thoughts on trends they think will be ubiquitous in 2015. It has been a privilege to glimpse their insights and rationales.
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We all have our own ideas about trends, and these are driven principally by what we believe will benefit our patients. Other considerations are the innovations themselves and whether they have legs or not. In my observation over a couple of decades, I have found that adoption of a new technology is a bit like the catwalk of a fashion show. Often what is in the headlines one year is nowhere to be seen the next. So when considering trends and predictions, I try to keep an open mind and not be too impulsive to adopt (and I am a self-confessed early adopter) or be too dismissive.
Economic issues play a considerable part, too, including the cost of adoption and whether the innovation has the ability to generate revenue. Femtosecond lasers for lens surgery are a case in point. The nay-sayers’ main argument is that the cost of the laser and its benefits, if any, do not justify the initial investment and ongoing revenue costs. Another most important influence is giving patients what they want. The trends in Europe are toward more lens procedures and fewer corneal laser procedures, and this is a result of demographic change: The population is getting older, and it is this group that has been relatively recession-proof.
Contributors to this issue have undoubtedly kept the above considerations in the backs of their minds, and, not surprisingly, there is consensus about trends for 2015. In the area of lens surgery, the emphasis on increasing the range of focus remains. Most lens technologies addressing this issue involve some level of compromise; what to compromise on is up to the operating surgeon. Enhanced depth of focus/extended range of vision is a new trend, and several implants such as the WIOL-CF (Medicem) and Symfony (Abbott Medical Optics) are already available. A degree of micro-monovision, however, seems to be necessary still—a compromise. Early results with small-aperture lenses are promising; however, there may also be compromises, such as poor visual function in low illumination. Accommodating IOLs are also back again, with newer devices such as the promising Fluidvision IOL (PowerVision). The Lumina IOL (Akkolens) has a clever design; however, as Liliana Werner, MD, PhD, points out, there are some theoretical issues such as pigmentary dispersion and inflammation because of the lens’ location inside the eye.
In terms of corneal refractive surgery, there does not seem much to smile about—except perhaps for ReLEx SMILE. Even so, this procedure is not likely to replace LASIK anytime soon. Will laser volumes increase? I agree with Robert Edward Ang, MD: This is unlikely, even if we are coming out of recession. I have my own theory as to why laser numbers are and will remain small, which is that LASIK has never reached its tipping point. In order for this point to be reached and for the technology to gain traction in the usual product cycle, 15% of the population—the early adopters before we move the exponential early majority—must adopt it. LASIK will stay, and numbers might grow a little, but it will never reach the magnitude previously imagined. On the other hand, retina looks like an exciting market, based on the article by Szilárd Kiss, MD. Online diagnostics, minimally invasive techniques such as 27-gauge vitrectomy, retinal prosthetics, and stem cell therapies sound futuristic, but all are here now. We also welcome the outlook for glaucoma, shared by Malik Y. Kahook, MD. Admittedly retina is a little outside my personal reach; however, I expect there is more likelihood of my adopting some of these new glaucoma techniques Dr. Kahook describes.
We thank our contributors for their outlooks on the coming year. It will be useful to review this issue again at the end of 2015 to see whose crystal ball was the most accurate.