Sean Ianchulev, MD, MPH: Microinterventional Cataract Fragmentation

Sean Ianchulev, MD, MPH, professor of ophthalmology at the Icahn Scool of Medicine and Director of the Ophthalmic Innovation Technology Program at New York Eye and Ear Infirmary of Mount Sinai, discussed with MD Magazine the benefit of using microinterventional fragmentation of the lens instead of phacoemulsification to aid in cataract surgery. The breakthrough technology, miLOOP, will change how cataract surgery is performed and how doctors fragment the lens, exposing the eye to less surgery.

Sean Ianchulev, MD, MPH, professor of ophthalmology at the Icahn Scool of Medicine and Director of the Ophthalmic Innovation Technology Program at New York Eye and Ear Infirmary of Mount Sinai:

Microinterventional lens and cataract fragmentation technology, which is fairly new. It's something we introduced earlier this year in the United States, and it uses microinterventional thin filaments, super-elastic technology, something that is used commonly in interventional radiology and also cardiology and it allows you to use those very thin filaments to go around the lens and then fragment the lens into pieces — normally we do this with phacoemulsification.

Well we know with phacoemulsification we're introducing a lot of energy into the eye and sometimes that's not very efficient and causes problems particularly when we have very dense nuclei and more advanced cataracts, where you end up using a lot of phacoemulsification power. And when you do this, you end up damaging the cornea or causing corneal edema. With this new system, we're able to actually use a pen-like device which is disposable and it uses micro-thing super-elastic filament that goes around the lens, fragments it, and then cut it into pieces without using any energy. And it uses in a different way where it fragments the lens by contracting and by cutting outside in, and everything in between gets fragmented versus the conventional phacochopping where we cut from the inside out and sometimes that put stress on the capsule.

It's actually now time to consider new paradigms and see how we can even do better. And so I think we're coming at that point where maybe microinterventional can allow us to do things that we can't do with phaco, and really eliminate energy that goes into the eye — vibrational energy, heat and all that really makes it hard. And then phaco has really not transformed the global cataract problem, because if you think about it, most of the cataracts are now in the developing world where phaco is used very, very rarely, because it's so difficult to train, it's a big capital expense and also it is very difficult and it has completely different complication rate and profile when you treat hard cataracts.

And what we're finding with this microinternational technology is cataract grade independent so you can do it on mild and very advanced cataracts with the same ease and efficiency. The learning curve we're finding is about 3 to 4 cases versus phaco surgical skill set transfer takes sometimes 500 or more cases.

It's a pen-like disposable device that we can take literally in the developed and developing world and transform and kind of change the odds of blindness from cataract surgery. So it's really exciting, in fact, we've done probably done this year about 6 humanitarian missions with the phacoemulsification with a miLOOP device where we've taken into different countries and has dramatically changed the game and the surgical experience of the surgeons.