Helping the underprivileged to see Some logistical considerations when setting up ‘eye camps’

Roughly 300 million people are visually impaired—38 million of whom are blind and most of whom live in so-called developing countries. However, there are many institutions with specific campaigns aimed at eliminating preventable blindness (for example, the World Health Organization’s ‘Vision 2020: The Right to Sight’ initiative), as well as associations (Lions, Rotary, Surgical Eye Expeditions, Orbis, Mercy Ships, Sight Savers and CBM to name but a few). Additionally, donation appeals fill post office boxes regularly.

In 1997, my friend and I, both ophthalmologists for more than 15 years at that time with plenty of surgical experience, travelled to Papua New Guinea to take part in a surgical eye camp under the auspices of Surgical Eye Expeditions (Santa Barbara, California, United States). Unfortunately, we were unsuccessful in achieving our goals, which was mostly down to issues such as the lack of infrastructure (microscopes, autoclaves), consumer goods (syringes, needles, drapes, etc.) and trained surgical nurses.

Therefore, we decided to found our own association, which we called “Vision without Frontiers” (www.sehenohnegrenzen.org), to gain donated money to optimise the outflow of an eye camp in 2000. We organised 41 eye camps in Namibia, Zambia, Zimbabwe, Tansania, Nigeria and Nepal.

Our responsibilities lie in creating or improving the infrastructure at the location where the camp is planned. This means perfect microscopes (not fixed on the operating table) are required, as well as at least two autoclaves and supporting kitpacks (including drapes, sutures, syringes, needles, patch, gowns, gloves, cannulas, knifes, keratomes, infusion sets, etc).

We also need to source staff, and it proves quite a challenge to find skilled colleagues and nurses who are physically and mentally strong enough to travel to unknown countries with unfamiliar potentially harmful diseases in their holiday time.

One of the most important persons for a successful camp is the host, who is usually an ophthalmologist who does surgery as well. He or she is responsible for a wide range of tasks including recruiting enough patients for surgery; bringing them to the clinic or an adapted ‘operation’ room; organising facilities for surgery; and ensuring the power supply for microscopes and autoclaves.

Costs have to be factored in from the beginning. For example, the price of transporting equipment from Europe to Africa, including surgical instruments for phaco and ECCE; IOLs; a keratometer; an ultrasound biometer; and several drugs, ointments, local anaesthetics, hylase and eye drops. These will all have to pass customs and be transported to the camp in a timely manner.

Last year we were invited to build an eye camp in a rural town in Nigeria, where a small hospital exists. The costs for infrastructure were €125,000 Euros, for consumables €20,000 and for logistics €20,000.

Our team comprised two doctors, four nurses and two ‘helping hands’, and we performed 139 cataract surgeries within 5 days. Thus, the cost of a single surgery was about €1,200.

However, this high price is expected to decrease over time as the number of eye camps in the country increases. In addition, at this camp a young Nigerian doctor is currently undergoing surgical training and will soon overtake this duty, so sustainability is guaranteed.

Wanting to help deliver ophthalmic care in developing countries is a wonderful idea, but the reality is that costs can be higher than expected, especially at the beginning and because of the high-quality work carried out. This has to be taken into account before you start.

However, whether it’s through the setting up of camps, donating your time or channelling your money to such worthwhile causes, enabling a patient to see again is worth almost any price.

Dr Christoph Faschinger

E: christoph.faschinger@medunigraz.at

Dr Faschinger has been an ophthalmologist for 40 years at the Department of Ophthalmology of the Medical University of Graz, specialising in anterior segment surgery (cataract, glaucoma, keratoplasty). He is founder of the association “Vision without Frontiers”, which encompasses almost 40 eye camps in several developing countries.

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Gastric Mucin from Pigs May Relieve Dry Eyes in Humans

Background An estimated 10% of adults have dry eye syndrome (keratoconjunctivitis sicca), a common ocular disease that occurs even more frequently among contact lens wearers. While the etiology of dry eye syndrome is still uncertain, the typical treatment for dry eye symptoms are lubricating eye drops.

Purified mucin MUC5AC for dry eye

Patients suffering from dry eye lack mucins—especially the gel-forming MUC5AC—in their tear fluid.

Although such eye drops can be effective in relieving symptoms, they lack mucins—large glycoproteins that serve as molecular lubricants on many epithelial body surfaces, including the tear film. Patients suffering from dry eye lack mucins—especially the gel-forming MUC5AC—in their tear fluid.

“It is likely that, in the absence of a proper mucinous lubrication layer on the cornea surface, increased friction and tissue damage induced by contact lens sliding lead to discomfort,” wrote Oliver Lieleg, PhD, and colleagues from the Technical University of Munich (TUM) in Germany, in a recent study.

To relieve that friction and tissue damage in contact lens wearers and others who suffer from dry eye, the researchers sought to replace the missing mucin in the eyes of dry eye patients. But where to get it?

“Since the mucin MUC5AC occurs in the tear film physiologically, using purified mucin MUC5AC might be a good alternative to HA-based lubricants,” they wrote. “However, obtaining sufficient amounts of purified MUC5AC from human tear fluid is obviously very challenging and not a good choice for commercial purposes.”

So, they turned from the eye to the stomach—a pig’s stomach.

“Interestingly, this mucin variant is also the main constituent of stomach mucus, and here the amount of mucus present is considerably higher than in tears,” wrote Dr. Lieleg and colleagues. “Since pigs are phylogenetically relatively closely related to humans and purified porcine gastric mucins (PGMs) are already used as a spray to treat oral dryness, those mucins could be a good choice.”

When they tested the PGM on an experimental pig’s eye, they found that the mucin did indeed prevent frictional damage to corneal tissue, and could be a “powerful tool” to treat ocular surface dryness as an artificial eye drop or as a molecular coating for contact lenses. Such a coating could be included in contact lens storage solution, which they wrote would “spontaneously form a protective coating layer on the contact lens material by passive adsorption,” or be integrated during the manufacture of the hydrogel contact lens material itself.

In this interview, Dr. Lieleg describes how well and how easily mucins adhere to, and protect, the corneal surface. He also explains why mucins haven’t been used as an ocular lubricant up until now, and he discusses the powerful potential of purified mucins not only for dry eye, but for many other medical applications.

MDLinx: What has prevented other researchers from successfully using mucins as a lubricant eye drop or as a coating for contact lenses?

Dr. Lieleg: So far, the main limitation has been that commercially available mucins lack critical functions found in native mucins—and, in the past, most researchers made use of those commercial mucins in their experiments. For instance, when the lubricating potential of mucins is probed, solutions containing commercially-purified porcine gastric mucins behave similarly to pure water/buffer, especially at low sliding speeds, which are relevant for the motion of contact lenses on the cornea.

Our current hypothesis is that those commercial mucins somehow get damaged during the purification process, and this chemical damage compromises their functionality. I believe that a lack of functional commercial mucin has limited research in this area quite a bit. Together with a colleague from KTH Stockholm, Prof. Thomas Crouzier, PhD, I have been trying to convince the field to stop performing research with those commercially available mucins and to invest the time and effort to purify the mucins in the lab so that their functionality is maintained. However, this purification is not trivial and somewhat time consuming, which is why some labs are still working with the commercial molecules. We are, however, already collaborating with several research labs around the world to try to provide manually purified, functional mucins for research as good as we can.

MDLinx: You wrote in your paper: “With recent progress made in the purification of those PGMs … it is likely that this limitation will be not an issue any more in the near future.” What is the “recent progress” you’re referring to?

Dr. Lieleg: We recently teamed up with colleagues from our department who specialize in purification technologies. Together, we could improve the lab-scale mucin purification procedure that was originally introduced by the lab of Rama Bansil, PhD, at Boston University. The goal of our study was to increase the yield (ie, the amount of mucin purified from a pig stomach) and to reduce the time of the purification process—while maintaining the functionality of the purified mucins.

With the adapted and improved purification process, the amount of mucins we can purify per week has significantly increased compared to what I used to obtain as a postdoc when I was conducting the purification process myself in the lab of Katharina Ribbeck, PhD, at Harvard/MIT. Having larger amounts of mucins available is one requirement for performing macroscopic experiments such as the friction and wear studies we published with contact lenses and corneal tissue.

MDLinx: How do you get the mucin to adhere to the hydrogel lens? Or, if the mucin is in contact lens solution or eye drops, how to they remain on the surface of the eye for long-term comfort?

Dr. Lieleg: In previous research, we (and others) realized that mucins spontaneously adsorb to a broad variety of surfaces including glass, steel, and PDMS. In our recent paper, we were pleased to see that our purified mucins also spontaneously adsorb to contact lenses. This passive adsorption is strong enough that we still find a protective mucin coating after performing friction experiments on cornea samples.

This ability of mucins to bind to a surface and—if sheared off by mechanical forces—to readsorb to this surface from solution is also a key reason for the great lubricative properties of this molecule. This mechanism is called “sacrificial layer formation.”

MDLinx: If the “sacrificial layer” of mucin is sheared off by mechanical forces, how does it readsorb quickly enough before it is sheared off again? Is the mucin floating freely in between the cornea and the contact lens, so it’s readily available to readsorb to the corneal surface?

Dr. Lieleg: This is exactly how it works. Sheared-off mucins will float in the liquid film between corneal tissue and the contact lens and will be able to diffuse back to the contact lens where they can readsorb. There will always be an interchange of floating mucins and adsorbed mucins, and this cyclic exchange of bound and unbound molecules driven by mechanical shear is one mechanism that reduces friction.

MDLinx: Do you have any idea how long the mucin lasts in the eye, either as a lubricating drop or incorporated on a hydrogel contact lens?

Dr. Lieleg: This we have not tested in detail yet. We probed if the mucin coating is still present on the contact lens after performing a tribological sliding experiment on cornea samples. We found that this is the case, so the coating seems to be quite stable (or the readsorption of sheared-off mucins is efficient enough to replenish the coating). Adding mucins into the bulk volume of the contact lens hydrogel might, however, indeed provide additional benefits as it could improve the hydration of the material and convey antibacterial properties (mucins show antibacterial qualities).

MDLinx: What is your next step in this line of research?

Dr. Lieleg: In addition to further improving the purification procedure of mucins, one goal is to develop a synthetic macromolecule that reproduces the great lubricating properties of mucins. In the long run, being able to synthesize a macromolecule as a component for eye drops or as a contact lens coating would have several advantages over purifying the complex mucin glycoprotein from animal tissue. However, for this approach to be successful, we still need to better understand what molecular motifs on the mucin glycoprotein are required for the different functions of mucins we and others have discovered in the past years. We are currently looking into this, but there is certainly more research required until we possess a detailed enough understanding of the structure-function relationship that renders mucins such an outstanding lubricant.

MDLinx: Your paper suggests other possible uses for this mucin, such as for easier insertion of a catheter or an intubation tube. Can you imagine any other potential uses for purified mucins?

Dr. Lieleg: Because mucins combine a broad spectrum of outstanding properties, there are certainly many other fields of medical applications for purified mucins. For instance, mucin coatings not only reduce or even prevent bacterial adhesion to surfaces, mucins also possess anti-viral properties since they are able to bind different viruses and reduce their infectious potential. Thus, mucins could be great components for hydrogels in wound treatment. With more and more functional mucins being available to the scientific community, I am convinced that we will identify even more highly interesting properties of this fascinating molecule.

About Dr. Lieleg: Oliver Lieleg, PhD, is an Associate Professor of Biomechanics and the head of the Biopolymers and Bio-Interfaces lab in the Department of Mechanical Engineering at Technical University of Munich (TUM), in Munich, Germany.

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Demand for Disposable Designs Will Fuel Surgical Instruments Market

Demand for Disposable Designs Will Fuel Surgical Instruments Market

Source: Market Scope

TUESDAY, FEBRUARY 07, 2017 

Aging populations and greater access to health care are spurring increases of 4 percent per year in ophthalmic surgeries worldwide through 2022, according to research firm Market Scope.

Market Scope’s recently published “2017 Ophthalmic Surgical Instruments Report” focuses on five categories of surgical instruments: reusable instruments, disposable instruments, reusable knives, disposable knives, and cautery devices. Increasing preference for disposable instruments and knives over the past decade has led to these devices accounting for nearly two-thirds of global market revenues. Ease of use, fear of cross-contamination, and cost of sterilization are factors that have enhanced the appeal of disposable instrument versions.

Global revenues for surgical instruments are expected to exceed $1.2 billion in 2017 and increase to nearly $1.6 billion by 2022 at a compounded annual growth rate of just over 5 percent, fueled by increases in the number of surgeries performed worldwide and rising demand for disposable instruments.

The growing trend toward ophthalmic microincision surgery is also significantly expanding market demand, especially in cataract and retinal surgeries, as surgeons use smaller-gauge instruments with increasing frequency. The trend is also expanding the popularity of disposable instrument versions because it is difficult to re-sterilize small-gauge reusable instruments without breaking them.

Market Scope expects reusable and disposable surgical instrument categories to benefit from worldwide growth in ophthalmic surgeries. Market Scope projects total global surgeries to grow from just over 41 million in 2017 to more than 50 million in 2022 at a CAGR of just over 4 percent.

Surgical instruments are used in all ophthalmic subspecialties, but cataract surgery is the most common procedure and offers the largest market opportunity, accounting for 63 percent of global ophthalmic surgeries and generating more than 56 percent of global revenues. Although representing only 4 percent of global ophthalmic surgeries, retinal surgery represents the second largest subspecialty segment, accounting for 22 percent of revenues in 2017. Fueled by an expanding variety of surgical instruments used in vitrectomy and a growing trend toward disposable versions, retinal surgery’s share of the global surgical instruments market will continue to increase through 2022. Together, cataract and retinal surgical instruments are expected to account for over 77 percent of global revenues in 2022.

The US is the world’s largest market for ophthalmic instruments, generating nearly a third of global revenues. The dominance of disposable designs accounts for the US market’s relatively large size. By 2022, fueled by a strong preference for disposable instrument designs, the US market is expected to increase to over a half billion dollars.

Western Europe is the second largest market. Together, the US and Western Europe are expected to account for nearly 60 percent of the worldwide market. We look for robust growth in revenues in the emerging markets of China, India, and Latin America, which will experience near double-digit growth in revenues over the next five years, driven by their expanding economies, growing elderly populations, improving health care delivery, and increasing use of disposable instruments.

More companies (more than 100 globally) compete in the surgical instruments market than any other surgical device category, but the market is dominated by relatively few companies, including Alcon, Bausch + Lomb, Beaver Visitec, Surgical Specialties, and Geuder. These companies together will account for 57 percent of global revenues in 2017. The largest of these is Alcon, with nearly 30 percent of the market.

The larger competitors tend to concentrate on disposable cataract and retinal instruments, the largest and fastest growing segments of the global instrument market. They also each have a strong presence in the largest markets, including the US and Western Europe.

Market Scope’s “2017 Ophthalmic Surgical Instruments Report: A Global Market Analysis for 2016 to 2022” is in its eighth edition. It was published in January 2017. For more information on the report, contact us at (314) 835-0600 or visit our website at market-scope.com.

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Storytelling – Why Some Business Ideas Catch On and Others Don’t

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How MDP Laryngoscopes Stack Up Against the Competition

 

 

 

 

 

COMPARISON CHART FOR REUSABLE HANDLES

 

Features                  MDP Heine SunMed Teleflex Welch

Allyn

Construction Extremely durable German grade stainless steel and brass and chrome plated High Quality Stainless steel Strong durable stainless steel 304-series stainless steel
Design Knurled design facilitates strong grip & prevents slipping Knurled design facilitates strong grip & prevents slipping Smooth finish ribbed design Textured grip for regular handle and Ergonomic grip with silicone cushioning for rechargeable handle Knurled Chrome Finish
Autoclavable

Cycles

4000 standard cycles of 134°/4 minutes* 4000 standard cycles of 134°C/4 minutes 132°C/3 minutes for Gravity Autoclave

 

                   Warranty    5 years        5 years 5 years 5 Years

 

* STERILIZATION: Ethylene Oxide (EO) or Steam Autoclaving

 

 

COMPARISON CHART OF LIGHTING FOR REUSABLE  

                             FIBER OPTIC HANDLE

  • MDP offers three light options: LED, Halogen, and Xenon.
  • LED consumes significantly less energy. 6.5 KW LED bulb output equals 50 KW Halogen bulb
  • More energy converted to light rather than heat. 11.5 W LED bulb = 60 W conventional bulb
  • A 2.5V LED is 3x brighter than 3.5V Halogen bulb
  • LED bulb lasts 2000 times longer than Halogen and Xenon

 

Therefore, the market trend is towards LED lighting, and the comparison chart is

provided for fiber optic LED handles only.

 

Parameter MDP Heine Welch Allyn SunMed Teleflex
LED Bulb

Voltage

2.5V for regular battery handle and 2.5V & 3.5V for rechargeable battery handles 2.5V for regular battery handle and 2.5V & 3.5V for rechargeable battery handles 2.5V for regular

& 2.5V & 3.5V rechargeable battery handles

2.5 V 1.5 V
Rechargeable Battery Nickel Metal Hydride (NIMH) battery NIMH or Lithium Ion Nickel Cadmium (Cadmium is toxic) Lithium-ion battery
Make Germany* Germany Germany    ?    ?
Intensity of LED light in     lux (lumen/m2) 100,000 lux for 2.5 V LED 100,000 lux for 2.5V LED
Bulb

Warranty

     50,000 Hrs. 50,000 Hrs. 50,000 Hrs. 35,000 Hrs. >10000

Hrs.

 

* If brighter light is required, LED bulb from Taiwan could be provided

 

COMPARISON CHART FOR DISPOSABLE FIBER

                       OPTIC LED LARYNGOSCOPE

 

Parameter        MDP    Heine Welch Allyn SunMed Teleflex
Handle Aluminum* or stainless steel Plastic or combination of handle shell and battery inserts Self contained unit w/smooth finish Reinforced Plastic Handle
Blade Stainless steel Plastic Plastic or solid metal Blade
LED Bulb Voltage 2.5 V 2.5 V 2.5 V 2.5 V 2.5 V
Bulb Make China China China China China
Intensity of LED light in Lux (lumens/m2)
Warranty 2 year shelf- life 3-year shelf- life

 

  • Unlike the competition, MDP disposable aluminum handle comes with batteries and LED lamp sealed inside the handle. Batteries and Lamp unit cannot be replaced
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MDP Single Use Instruments

 

SAVE OVER $250K ANNUALLY

BY SWITCHING TO DISPOSABLE CATARACT INSTRUMENTS

Hospitals and surgery centers often stick with the same vendors and products that they’ve been using for decades. This allegiance has them miss out on new technological innovations that can save both time and money. Disposable instruments are the future of the profession.

 

We ran a diagnostic for XYZ EYE CLINIC and found they could save $255K a year on cataract surgeries alone. This is hard math, not fun with numbers. A surgeon’s cataract set includes instruments that are precise to within a hundredth of a millimeter. Maintaining such precision is only possible if replacing sets after every ten-to-fifteen applications. But disposable instruments are more affordable than ever before, rending stainless steel equipment all but obsolete.

 

A quick breakdown:

  • Disposable instruments are less expensive than even the most durable reusable pieces
  • They eliminate the cost and hassle of cleaning and sterilizing gear between surgeries
  • They further eliminate the risk of cross-contamination, and thus the risk of related lawsuits

 

If you’d like to see the math, we’re happy to show you. What’s more, if you’ll give us a few figures, we’ll get back to you with expected savings on whatever procedures you’d like calculated. We specialize in ophthalmic, laryngoscopic, and sterilization products. All of our products are guaranteed for quality and precision.

If millions to gain and nothing to lose sounds good to you, I look forward to hearing from you at sales@medicaldevicepurchase.com or 916 663 4165.

 

Very Sincerely,

Orin Ray, Owner of Medical Device Purchase (MDP)

 

 

 

NOTE: This paper is proprietary and cannot be circulated without written permission from MDP.

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Ophthalmic Instrument Manufacturing

Ophthalmic Instrument Manufacturing: Market Research Report

Market Research • Market Size • Industry Statistics • Industry Analysis • Industry Trends

Ophthalmic Instrument Manufacturing Market Research Report | NAICS OD5648 | Nov 2016

Looking up: An aging population and higher disposable income will bolster revenue

IBISWorld’s Ophthalmic Instrument Manufacturing market research report offers insightful industry analysis and research into the market at the national level. IBISWorld’s in-depth industry market research is presented in a logical and consistent format. The industry report contains key industry statistics, market size, industry trends, and growth and profit forecasts for a 5-year outlook period.

Report Snapshot

Industry Statistics & Market Size
Revenue

$5bn
Annual Growth 11-16

2.4%
Annual Growth 16-21

Annual Growth
Profit

Profit
Employment

10,332
Businesses

74
Industry Threats & Opportunities
    • Advancements in surgical techniques have made eye surgery quicker and less painful
    • International demand for eyecare services and ophthalmic equipment strongly grew
    • More affordable access to vision correcting services will also drive demand for ophthalmic equipment

… purchase to read more

Industry Analysis & Industry Trends

Over the five years to 2016, the Ophthalmic Instrument Manufacturing industry has benefited from a progressively aging US population, as eye problems closely associated with age, which increased demand for ophthalmic equipment sold by this industry. Advancing age has sent seniors, in increasing numbers, to optometrists to seek corrections for common refractive eye disorders, such as nearsightedness. Furthermore, corrective vision procedures have become more affordable for US consumers over the past five years, as increasing employment, disposable incomes and expanding access to health insurance encouraged more people to seek professional eyecare services. A projected continuation of these trends should support the industry in the five years to 2021… … purchase to read more

Industry Report – Industry Analysis Chapter

The Ophthalmic Instrument Manufacturing industry is driven by a number of factors, including aging demographics, surgical and product innovations, economic growth, increasing health insurance coverage and an expansion in demand from overseas markets. Over the five years to 2016, the progressive aging of the US population helped foster industry growth, as elderly individuals are more likely to develop eye diseases; their increasing numbers has fueled a rise in medical and nonmedical eye surgeries. Industry demand has also been driven by advancements in surgical techniques, such as minimally invasive laser procedures, which have made medically necessary eye surgeries safer and less painful. Mor.. … purchase to read more

Additional Insights for the Ophthalmic Instrument Manufacturing Industry

IBISWorld identifies 250 Key Success Factors for a business.The most important for the Ophthalmic Instrument Manufacturing Industry are

  • Access to the latest available and most efficient technology and techniques
  • Undertaking technical research and development
  • Protection of intellectual property/copyrighting of output

IBISWorld analysts also discuss how external factors such as Number of adults aged 65 and older and Number of people with private health insurance in the Ophthalmic Instrument Manufacturing industry impact industry performance

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