1/3/18 Believe It...or Not! ! Disclosures" A Peek Behind the Curtain at the Future of Eye Care! • No financial interest in any product discussed" ! • Some past lecturing and/or paid research for Alcon, ! "Allergan, Bausch & Lomb/Valeant, Pfizer, & Inspire" ! • Mention of these products in no way implies endorsement ! "by the presenter" • (mention of these products in no way implies expertise on Chris Wroten, O.D. "behalf of the presenter either!)" [email protected] Believe It or Not... ! • Alternative Health Care Technologies" • Contact Lenses" Alterna(ve Healthcare Technologies • Traditional Technology Advances" • Non-Traditional Healthcare Delivery" • Scope of Practice/Scope of Payment" Contact Lenses... • Registries" • Medicare Payment Reform" • Implantable Technologies" • Cataract Surgery Advances" • Presbyopia Management Options" • Lesion Removal & Cosmetic Therapies" • Miscellaneous Therapeutic Advances" NaturalVue from Visioneering Technologies 3-D Prinng • Richard Griffin, O.D. Ophthalmic applicaons • NEI Grant to develop • Contact Lenses? • 14 patents • So@, daily disposable mulEFocal, etafilcon A • “NeuroFocus Opcs” • Center distance, extended depth oF Focus design • Single add power • Myopia progression control?...regression?!?! 1 1/3/18 Triggerfish (Sensimed) Hyper-CL (EyeYon Medical) FDA-approved in U.S. March 2016 • Israeli Company Connuous IOP-monitoring from silicone CL • HyperosmoEc CL to treat K edema (with hypertonic g) • FDA-approved 2016 Telescopic Contact Lenses (for AMD) • Swiss Researchers (DeFense Advanced Research Projects Agency) • Contains miniscule mirrors arranged to mimic Galilean telescope, acEng like Built-in Binoculars; can Be paired with receiving specs • Challenge is thickness (1.55mm vs normal 0.35mm) Courtesy: cnn.com Also adjustable focus MF CL, too? Night Vision Contacts?!?! Alterna(ve Health Care Technologies “Tradi(onal” Technology Advances 2 1/3/18 Adjustable Focus Glasses: Adlens Focuss Kinec The image cannot be displayed. 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Horus • Similar product • Assesses paent's visual needs & facial features • Advanced so@ware calculates ideal lens posiEon in relaon to the eyes, then designs Frame Based on those unique parameters • 3D prinEng allows Further customizaon oF the Frame according to paent’s visual, comFort & aestheEc needs Other “Smart” Specs... Will wearable technology also change the way we • Carl Zeiss SmartOp(cs correct refracve disorders & interact with the world? • Google Glass • Mad Glass • Senth IN1 • Sound Glasses • iGlass? • others 3 1/3/18 Other “Smart” Specs... OAKLEY • CTRL Eyewear • Oakley Prizm Lenses • Polarized • Color-opEmized (Green=GolF, Blue=Fishing, etc.) • Oakley Radar Pace • $495 • AI Sunglasses • Biometrics + “Coach” Other “Smart” Specs... Project Blaid (Toyota) • Amblyz (XPAND)- digital LCD • Wearable device that scans the amblyopia “patch” glasses environment • Programmable • Uses cameras & recogniEon so@ware • “Good” eye lens alternates • Will integrate: clear to opaque x 30 secs • Mapping • Study of 33 kids, age 3-8 yrs • OBject ID (doors, Exit signs, stairs, with moderate amblyopia escalator, restroom signs, etc.) (20/40-20/100): 4 hrs of • Facial recogniEon technologies Amlbyz = 2 hrs patching • Users can request locaon oF certain things & FeedBack audiBly or By viBraon Proximity Hat MyEye (OrCam) • For visually impaired & those in poor lighng condions • Already successFully tested in Germany • Scans environment 50 x’s/sec • Applies pressure to wearer’s head in direcEon oF oBstacle 4 1/3/18 Horus • Samsung • Lan “return Back to the light” • Uses image processing • Modes: • Regular (enhances outlines) • Color Invert • ParEal Vision • Scotoma Relocator • Tunnel Vision • Display Color Filter Digital Vision Opmizer (DigitalVision Systems) Digital Vision Opmizer (DigitalVision Systems) • Virtual reFracEng plaorm to dx vision disorders & procure customized, digital, Free-Form lenses/glasses • Paents interacEvely choose & opEmize design oF their correcEve lenses under natural, real-world viewing condiEons • Provides “BeWer vision and viewing comFort than convenEonal eyewear procured using error-prone phoropter measurements” • Vision tesEng & fing inFo xmied to lab • Partners: Essilor, Zeiss, Hoya, TransiEons, Ga. Tech, others 3-D Prin(ng: Surgical Applica(ons? Alterna(ve Health Care Technologies Australian Co. Anatomics/Lab 22 @ CSIRO Non-Tradi(onal Technology Advances 3-D printed Ti sternum/rib cage successfully implanted in cancer pa(ent in Spain 5 1/3/18 3-D Prin(ng: Surgical Applica(ons? 3-D Prin(ng: Surgical Applica(ons? Wake Forest BapEst Medical Center: • EpiBone Integrated Tissue & Organ PrinEng System (ITOP) • Employs 3-D bioprinng to produce living human Essues & Bone 3-D Prin(ng: Surgical Applica(ons? 3-D Prin(ng: Surgical Applica(ons? Corneal Confocal Microscopy (CCM) • Examines unmyelinated corneal nerve fiBers @ high mag, using Lens Autofluorescence laser-scanning CCM to image corneal suB-Basal nerve plexus New possible • Using Lens Fluorescence Biomicroscope caliBrated with standards indicaon for • Predicts insipient peripheral neuropathy in Type 1 DM traceable to Naonal InsEtute oF Standards and Technology (NIST): diagnosing MS (63% Sensive; 74% Specific) • Type 2 DM DetecEon (via AGEs on lens) • Reduced Corneal NFL length & Corneal sensiEvity = increased • SensiEvity = 67%, Specificity = 94% severity diabeEc peripheral neuropathy (HemogloBin A1C: Sens.= 44%, Spec.= 79%) • Previous studies demonstrate uElity For CCM in other neuropathies (FasEng Plasma Gluc.: Sens.=50%, Spec.= 95%) • Takes 6 secs, non-invasive, doesn’t require FasEng 6 1/3/18 Lens Autofluorescence my Vision Track (a.k.a. mVT) from Vital Art and Science • FDA-approved • Rx only, Free download* • Home monitor • AMD & DR *Charge to share FDA Market Clearance 2013 data with doctor Epigene(cs... 23andME • FDA-approved • Direct-to-consumer genotyping • 36 condiEons currently(Sjogren’s, Sickle Cell) • Glaucoma?, AMD?, RP?, Color Deficiency? • Salivary sample 7 1/3/18 Color Vision Deficiency... Color Vision Deficiency • App-Based products • DiagnosEc? • Daily use... enchroma 8 1/3/18 Red-Green Color Blindness Colorblind Cure.flv - YouTube New Test for Color Blindness Regenera(ve Medicine: Stem Cells • Shinya Yamanaka (Japan) • 2006 discovered pluripotent stem cells (iPSCs) • NoBel Prize • Allows scienEsts to regenerate any type oF cell into an emBryonic cell • Companies now developing treatments to “replace damaged corneas” (expected to launch in Japan in 2018) & AMD...who? 9 1/3/18 Stem Cells: Ocata Therapeucs/Astellas Stem Cells: Ocata Therapeu(cs/Astellas Skin-to-Eye Stem Cells Transplant? Sept. 2014 • Luxturna (voregene neparvovec-ryzl) Yasuo Kiromoto, M.D., Ph.D, @ Kobe City Medical Center Gen. Hosp. st • Gene therapy For inherited reEnal dystrophies Performed 1 -ever human skin cell xplant in 70-yr old Japanese female • Succeeded in late-stage clinical trial • Paent’s skin cells used to generate induced Pluripotent Stem Cells • 1st gene therapy For geneEc disorders to win FDA approval in U.S. (iPSCs) (Dec. ‘17) • iPSCs then used to create ReEnal Pigment Epithelium (RPE) sheet • 2 gene therapies For cancer have also Been approved • RPE sheet then implanted in paent’s eye • Cost? • 1 year later: no rejecEon & suBjecEve improvement in sight Skin-to-Eye Stem Cells Transplant? Stem Cells...for Cataracts!?!? 03/09/16 Journal Nature: Sep. 2016: Another team at Japan’s RIKEN Center For Developmental Biology... “Stem Cells were Successfully Used To Treat Congenital Cataracts In 12 Babies” • Used major histocompaBility complex (MHC) matching to grow RPE cells From induced pluripotent stem cells (iPSCs) in skin cells with no • Univ. CaliFornia-San Diego scienEsts, in conjuncEon with Shiley Eye InsEtute & rejecon researchers in China, used stem cells &... • • Reported the inFants “regrew lenses” that are “FuncEonal and appear to act Could allow “RPE Banks” normally in the inFants, who are now toddlers” 10 1/3/18 •