Meeting Review

In its first year Ophthalmology Futures 2012 European Forum played host to a diverse panel of key members of the ophthalmology community from industry, academia and financial investment practices, discussing the future of ophthalmological specialities. "This event was really aimed at examining where our specialty is going in the future and providing an opportunity for cross fertilization of ideas and development of ideas," asserted Mr Keith Barton (Consultant Ophthalmologist, Moorfields Eye Hospital, London, UK, and co-founder of the meeting).

The rationale for hosting such an event in Europe was the level of innovation happening within the market. "There's more innovation in ophthalmology and certainly more surgical innovation in Europe than anywhere else in the world," said Professor Kuldev Singh (Professor of Ophthalmology, Director Glaucoma Service, Stanford University, Stanford, USA, and co-founder of the meeting). "We felt there was a need to have such a meeting in Europe."

Focusing on glaucoma devices, refractive surgery, cataract and intraocular lens (IOL) technology as well as pharmaceuticals, the full day of discussions enabled professionals to gain an insight into the current innovations and opened up networking opportunities within the growing ophthalmology market.

Glaucoma in focus

Introducing the subject of glaucoma Mr Barton highlighted that, "Glaucoma is the most common cause of irreversible blindness in the world." Affecting a large number of people in both the Western world and developing countries there are still many people who are undiagnosed. "The population at risk of glaucoma will increase by 50% in the next 30 years due to changing population demographics," he continued.

"Elevated eye pressure in the most common type of glaucoma, open-angle glaucoma, is due to resistance to aqueous humor flow through the trabecular meshwork," said Mr Barton. Currently, the standard practice of treating glaucoma is through pressure reducing medical therapy. However, these sorts of drops are required for the duration of a patient's life leading to compliance issues. Additionally, Mr Barton noted that many patients are unable to tolerate the medical therapy or simply cannot afford it.

"While you could argue with the logic behind our current treatment algorithms, it's quite possible in the future that minimally invasive surgery after medication or laser would obviate the need for more invasive surgery in many patients and will likely provide an alternative to medical therapy in many patients," he said.

Progression of glaucoma surgery

"There has been a slow evolution in traditional glaucoma surgery," added Prof. Singh. "We're doing tubes and trabeculectomies much as we did 10–20 years ago but there's now an explosion of new procedures that are combined with cataract surgery."

This new and exciting development in the field of glaucoma has led to a paradigm shift in the management of coexistent cataract and glaucoma. "Thus we have a slow evolution of the field for the surgical treatment of glaucoma, which is refractory to medical and laser therapy, but a rapid revolution in the treatment of nonrefractory glaucoma, which may be controlled with medications and laser, but cataract surgery offers the opportunity to perform a combined procedure with a novel technique to reduce the postoperative dependence upon glaucoma medications and to better control IOP." said Prof. Singh.

In agreement Mr Greg Kunst (Global Marketing Director for Glaucoma Surgery, Alcon, USA) said, "If you look at the market today there's a big gap that exists between medical therapy and surgical therapy. But clearly there is an emerging space for minimally invasive, safe glaucoma procedures."

Although the entire panel had not acknowledged major changes in their surgical practices over the past five years, there was a general consensus about the interest in new procedures and the potential of increasing safety through these innovations.

"These procedures are fantastic and are extremely tempting for surgeons because you can fall in love with them easily but we need data," said Professor Stefano Gandolfi (Ophthalmology Clinic, University of Parma, Italy). "We need randomized clinical trials that have been performed well and I would in particular encourage companies supporting these trials to comply with the guidelines that the WGA sets out when presenting the data. In this way we can evaluate surgical procedures much better."

A further point to this is the potential of growth borne out of the rising combination market of cataract and glaucoma surgeries. "Looking at markets, such as India and Asia, there is a much higher instance of narrow angle glaucoma, I think that the cataract market will grow dramatically as a treatment for glaucoma," said Professor Gabor Scharioth (Senior Consultant, Aurelios Augenzentrum, Recklinghausen, Germany).

"My concern in the trials with micro invasive glaucoma surgery (MIGS) is that very often they do the combined procedure and it's quite uncommon to see a straightforward comparison between the single procedures versus the companion procedures because the phaco always helps in decreasing IOP," countered Professor Stefano Miglior (Head of the Department of Ophthalmology, Policlinico di Monza, University of Milan Bicocca, Italy).

"So, for a practitioner in the developing world, to be able to address glaucoma in a safe and effective manner, there is certainly a clear need," added Mr Kunst.

Innovative devices

To highlight some of these innovative devices that could be driving factors for the evolution of the field of glaucoma, Mr Barton chaired a session where several companies for the USA and Europe (Implantdata Ophthalmic Products, InnFocus, EyeTechCare, Aquesys, Ivantis and Transcend Medical) showcased their innovations. Technologies included a 24-hour IOP monitoring device, ultrasound circular cyclocoagulation, novel polymer glaucoma stents and MIGS.