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Emerging Technology in Eyecare Indiana 2021

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Emerging Technology in Eyecare Indiana 2021 Emerging Technology In Eyecare Dave Anderson, OD [email protected] Tim Fries, OD, MBA, MPH [email protected] Jason Miller, OD, MBA [email protected] www.theweyesguys.com wEyes Guys Tim, Jason and Dave Optometrists helping Optometrists DISCLOSURES DAVE ANDERSON, OD BUSINESS CONSULTANT, WEYES GUYS MYOPIA MANAGEMENT KOL, ESSILOR CONTRIBUTING AUTHOR, REVIEW OF OPTOMETRIC BUSINESS IDOC MEMBER DIRECTOR CONTACT LENS CLINICAL INVESTIGATOR BAUSCH & LOMB JNJ VISION CARE ALCON TIM FRIES, OD, MBA BUSINESS CONSULTANT, WEYES GUYS VSP AMBASSADOR IDOC MEMBER DIRECTOR CONSULTANT SPEAKER - OPTOS CONSULTANT SPEAKER - NEUROLENS DISCLOSURES JASON MILLER, OD, MBA BUSINESS CONSULTANT, WEYES GUYS CONTRIBUTING AUTHOR, REVIEW OF OPTOMETRIC BUSINESS ADVISORY BOARD SUN PHARMA ALLERGAN ALCON CLINICAL INVESTIGATOR BAUSCH & LOMB JNJ VISION CARE ALCON NEW TECHNOLOGY IS IT WORTH THE INVESTMENT OF TIME, MONEY AND STAFF TRAINING? TECHNOLOGY IN LECTURE FORM TEXT: DAVIDANDERSO446 (O NOT ZERO) TO THE NUMBER: 22333 Emerging Technology Objectives • Cover common patient complaints that have no easy answers and the new technology that can help diagnosis and treat them • Headache and eye misalignment • MGD and new treatment options • Presbyopia drops • Genetics in eyecare Contoured Prism What is different about neurolens® • A proprietary lens technology Neurolenses Standard integrating a contoured prism Traditional Prism Lenses design in conjunction with the Lenses patient’s refractive prescription. • Contoured prism technology enables practitioners to relieve binocular misalignment detected at distance, intermediate, and near in a single lens. • Research indicates that over 90% of patients experience a larger misalignment when fusing at near than at distance.1 1. Oculomotor Functions & Neurology-Indiana School of Optometry Contoured Prism The Digital Transformation 3000 9 6.75 2250 4.5 1500 Billions Millions of Units 2.25 750 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 0 Population 2000 2002 2004 2006 2008 2010 2012E 2014E 2016E Mobile-cellular subscriptions Personal Computers Smartphones Tablets Trigeminal Dysphoria • Proprioceptive fibers innervating the extraocular muscles provide afferent feedback to the brain about the location of each eye. • This feedback is required to avoid binocular misalignments. • These proprioceptive signals are transmitted through the ophthalmic branch of the trigeminal nerve, which is responsible for detecting sensation and reporting pain. • It appears that these signals play a large role in the stimulation of the trigeminal nerve, resulting in symptoms associated with Trigeminal Dysphoria. American Optometric Association (AOA Clinical Care Group). April 1997. Leigh, R., Zee, D. The Neurology of Eye Movements. Weir, C., Journal of Neuro-Ophthalmology. Vol. 26, No. 2. 2006. The Vision Council. Accessed April 2018. J Neuro-Ophthalmol 2018; 38: 237-243 Symptoms of Trigeminal Dysphoria Symptomatic patients shared a common trait: a misalignment in their vision* *Results from a series of clinical studies on headache patients Eye Tracking and Independent Displays Purkinje Case Study 65YO White Female Symptoms: Tired, dry eyes daily and severe motion sickness for many years. Motion sickness so bad she has not been able to ride in a car for more than a few minutes/miles at a time. She is unable to drive, her husband has to do all the driving. RX OD +4.00 -0.50 x 095 OS +4.75 -0.50 x 075 +2.50 add current PAL wearer x many years. Demo 1BI and 1.5 BI flippers, decided to RX a 1.3 BI Meibomian Gland Treatment Maintenance/home care: heat masks (many options), lid hygiene including hypochlorous acid for Demodex, tea tree oil, diet/supplement changes Manual: Miboflow, TearCare, iLux, IPL Doctor is able to visualize the oil glands function and composition during/after treatment Automated: Lipiflow Set it and forget it Tear Function and MGD Most studies suggest nearly 70% of dry eye has some form of MGD leading to the signs and symptoms Evaporative dry eye is most common cause of dry eye Improving Signs Clin Ophthalmol. 2018; 12: 683–694 Improving Symptoms Clin Ophthalmol. 2018; 12: 683–694. Mibo Thermoflo Ultrasonic heat applied to eyelid through ultrasonic gel Temperature maintained at 108.5 degrees Cost $18,000, but no cost per use Uses silver heat inducer that is antimicrobial, and is cleaned either with alcohol or hydrogen peroxide Meibography can be added to aid treatment (MiboCam - cost approximately $9000) Requires 20-30 minute tech time, and approximately 10 minutes of doctor time expressing glands, each eye is treated separately May take 3-4 visits, provides 6 months of symptom relief MIBO THERMOFLO • EASY TECHNICIAN USE • COMFORTABLE FOR PATIENTS • EFFECTIVE TREATMENT • COST IS LOW • NO REUSABLES TO PURCHASE MIBOTHERMOFLO TearCare by Sight Sciences Thermal heat applied to eyelid through small disposable heating pads that are temperature controlled during treatment Temperature maintained at 108.5 degrees at inner lid, ranges from 106-113, but can be controlled if patient more sensitive Cost $5500 for starter kit, with $250 per use for each heating pad Open eye, encouraging blinking during treatment and no heat accumulation to the ocular surface Both eyes done simultaneously Requires 15 minute tech time (not continuous), and approximately 10 minutes of doctor time expressing glands Takes 1 visit, provides 6-12 months of symptom relief TEARCARE • EASY TECHNICIAN USE • COMFORTABLE FOR PATIENTS • EFFECTIVE TREATMENT • COST IS MODERATE TO LOW • OPEN EYE PROCEDURE HAPPY PATIENTS Beginning of treatment Mid-treatment MG Expression Treating Presbyopia with Drops Presbyopia affects more than 1.8 billion people worldwide, 11million in the US Two Kinds of Eyedrops Miotic Drops – Smaller pupil size = “pinhole effect,” greater depth of field Lens-Softening Drops Softens the eye’s aging lens, allowing it to be more flexible and adjust/focus for near vision Treating Presbyopia with Drops Miotic Drops: Some companies developing miotic drops: Allergan Presbyopia Therapies Orasis Pharmaceuticals Treating Presbyopia with Drops Lens Softening Drops: - turn back the clock 10 years Novartis EV06 ophthalmic solution 1.5% (lipoic acid choline ester) – Phase 2 trials Best for people without cataracts and in early stages of presbyopia Liquid Vision (Presbyopia Therapies) Marketed as a “Lifestyle Drop” designed to last 5 hours or more Aceclidine (miotic) & tropicamide (cycloplegic) to create a “superpinhole effect” and moderate accommodation “Lifestyle enhancement” to be used with glasses/ contacts Genetic testing in eyecare Targeted treatment and care regimen vs. standard of care cook-book care regimen ARMD Inherited retinal disorders Achromatopsia Keratoconus Lattice and Granular Corneal Dystrophies Retina Genetics Testing Spark Invitae genetic test for inherited retinal diseases including RP, Lebers and others Arctic Macula Risk and Vita Risk genetic tests that assess risk for ARMD progression and best supplement based on genetic profile Invitae genetic test for IRD (Inherited Retinal Disorders) 248 genes tested RP Lebers Stargardts Rod-Cone Dystrophy Vitelliform macular dystrophy Retinal findings associated with Syndromes including Usher, Stickler and many others Other Genetic Tests Spark Retinal Gene Therapy Luxterna (voretigene neparvovec-rzyl) First FDA approved gene therapy for RPE65 deficiency Gene is delivered directly into the eye Cost of the procedure up to $500,000 per eye Treatment center at Cincinnati Childrens Also available at Bascom Palmer, Mass Eye/Ear, others Arctic Vita Risk test Vita Risk is a DNA test measuring the two main genetic variations (three genetic variations in two genes) that interact with common vitamin/mineral supplements containing zinc. People in one genetic group have increased risk of progression of age-related macular degeneration to wet AMD. Some patients have higher potential for worsening using current AREDS 2 supplements due to higher levels of zinc, most AREDS 2 are 25-80mg/d 15% of patients respond negatively to high levels of zinc Arctic Macula Risk Macula Risk is a DNA test combining many of the genes (15 genetic variations in 12 genes) associated with the progression of age-related macular degeneration (AMD). The genetic result is integrated into a formula developed from research at Tufts Medial Center and includes a patient’s age, AMD disease status, height, weight, sex, and smoking history, which provides a basis for progression risk. The report provides a two, five and 10-year prediction of the risk for progression to lost vision from advancing AMD. This test was 89% accurate in its published research. TGFBI Gene Transforming growth factor beta induced TGFBI is key factor several corneal dystrophies: Granular corneal dystrophy, type 2, Reis-Bücklers Corneal Dystrophy, Thiel-Behnke corneal dystrophy, and Lattice corneal dystrophy Cytogenetic Location: 5q31.1 Avellino Labs USA, Menlo Park, CA - AvaGen Cost: $8-17, depending on condition evaluated Screens for keratoconus and currently FIVE other corneal dystrophies Uses: Pre-LASIK consult? Newly diagnosed corneal dystrophy, family Hx of “corneal problem” or for future children’s risk Gene therapy on the horizon for keratoconous and these dystrophies Other New Tech MiSight - Coopervision Myopia Management Lens MYOSIGHT - HOYA DIMS (defocus incorporated multiple segment) Right Eye Vision Training VR Visual Fields A-Scan by DGH axial length measure for Myopia Management wEyes Guys OPTOMETRY CONSULTING Dave Anderson, OD [email protected] Tim Fries, OD, MBA, MPH [email protected] Jason Miller, OD, MBA [email protected] www.theweyesguys.com.
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