APACRS 2021 Daily News (Sunday, 1 August 2021)

Asia-Pacific Association of Cataract & Refractive Surgeons Sunday, 1 August 2021 IOL Innovations – Preparing for the Future Experts sifted through the glut of innovative new IOL designs to sort the wheat from the chaff in an APACRS Symposium held Saturday. Chandra Bala, PhD, MBBS, FRANZCO, Australia, provided a “generic overview and homage to the great innovators,” present- ing a diagram of the birth and growth of IOLs with the 1949 work of Sir Harold Ridley at its base. The material of that first lens, PMMA, would be the dominant material over the next 30 years until the next major design innovation in 1989 and 1990, when AMO and Alcon consecutively introduced the first foldable IOLs. In summary, Dr. Bala said that while significant changes have been made in both optic and haptic design, the current suc- cess is owed to the pioneering work of engineers, doctors, and patients. Some of the more popular IOL designs today incorporate ex- tended-depth-of-focus (EDOF) technology; Gerd Auffarth, MD, PhD, FEBO, Germany, discussed three groups that use three different approaches to EDOF: Monofocal+ IOLs, such as the Johnson & Johnson Vision (J&J) TECNIS Eyhance, the Bausch + Lomb (B+L) LuxSmart, the Physiol/BVI IsoPure, and the Santen Xact MonoEDoF; classical EDOF IOLs such as the new AcrySof IQVivity (Alcon); and trifocal and hybrid IOLs such as the J&J TECNIS Synergy and Physiol/BVI Trivium. The Monofocal+ IOLs employ different optical concepts but resulting in a dysphotopsia profile “remarkably like” monofocal IOLs; the newer classical EDOF IOL Vivity employs a non-dif- fractive concept based on wavefront-shaping technology; and finally the hybrid optical tech IOLs combine traditional EDOF multifocal or trifocal patterns with improved near performance, optimized low light vision, and reduced dysphotopsias. One of the more striking IOL innovations is an IOL whose re- fractive power can be adjusted after implantation. Robert K. Maloney, MD, USA, discussed the Light Adjustable Lens, an IOL made of a photosensitive material that changes power when exposed to ultraviolet light using a Light Delivery Device. At 2 weeks after implantation using any standard cataract surgery technique, the surgeon sits down with the patient to determine the best refractive target for them—emmetropia in both eyes? monovision? minimonovision? mild undercorrection? EDOF? “You can customize the vision in a way you never can with a non-adjustable lens because you can’t test any of this before surgery because they have a cataract,” Dr. Maloney said. He concluded that LAL is the most accurate IOL and allows customization of vision after cataract surgery; the extra effort necessary as the IOL power is locked in over several light treat- ments, he said, is manageable, and he believes that LAL has an important place in any cataract practice. “I can’t imagine a leading cataract practice that doesn’t offer this product,” he said. Wrapping up the symposium, Michael Lawless, MD, Australia, discussed which IOL he would have for himself given the op- tions available in 2021. Dr. Lawless said that he is left eye dominant, with that eye at 6/6 unaided. His nondominant right eye had previously undergone LASIK; the surgery aimed for -1.50 D for monovision, though having drifted over time is currently at -0.75 D corrected to 6/6. So: Good distance, happy to use reading glasses. Having had previous refractive surgery, he has biometry and keratometry data available; he would use the Barrett True K TK for IOL power calculation. For his dominant eye, he would have a Clareon aspheric IOL (Alcon), aiming for plano, and for his nondominant eye, a Vivity aiming for -0.75 D. EWAP Daily News - 7