EyeWorld Asia-Pacific June 2012 Issue

31 EWAP CATARACT/IOL June 2012 substance not foreign to the ocular environment. Although sizing is always an issue when surgeons are putting an IOL into the capsular bag, it hasn’t presented a significant problem thus far. “One always wonders what will happen in the long term,” said Dr. Nichamin. “Will the lens wear out? We’ve had accelerated bench testing show the internal movement of the lens should last for many decades, but one doesn’t know until it’s implanted in-vivo what type of long-term changes occur as the capsular bag fibroses.” Views from Asia-Pacific The MPlus IOL Source: Oculentis GmbH The FineVision IOL Source: Erik L. Mertens, MD, FEBOphth GUO Haike, MD Department of Ophthalmology, Guangdong Eye Institute, Guangdong General Hospital 106 Zhongshan Er Road, Guangzhou, China Tel. no. +86-20-83844380 Fax no. +86-20-83844380 guohaike@medmail.com.cn M ultifocal and accommodating IOLs were introduced two decades ago and have gone through several iterations. Accommodative IOLs have been an intriguing method of addressing presbyopia primarily because they attempt to mimic Mother Nature’s mechanism of accommodation. Surgeons have also warmed to them because they appear to pose a greatly decreased risk of visual aberrations such as halos or contrast sensitivity loss. Currently, there are two broad categories of lenses within the presbyopia- correcting category that have gained FDA approval: (1) Multifocal lenses, which currently include the ReSTOR (Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland), the ReZoom and the Tecnis Multifocal (Abbott Medical Optics, AMO, Sta. Ana, Calif., USA) lenses and (2) Accommodative lenses, which currently includes the Crystalens and Crystalens HD (Bausch + Lomb, B+L, Rochester, NY, USA). A handful of developers, including PowerVision (Belmont, Calif., USA), Oculentis (Berlin, Germany), and PhysIOL (Liège, Belgium) also attempt to mimic the eye’s natural method of focusing. Regretfully, these lenses are widely used but not approved by the FDA. The FluidVision lens relies on a shape change of the anterior optic in order to create “dramatic” optical power shifts in the eye. The MPlus by Oculentis combines two spherical surfaces with different radii which creating two defined focal points. The distinctive feature of the lens is that the light—when it hits the transition area to the embedded sector element—will be reflected away from the optical axis. On the one hand, it will result in a minor loss of light intensity; on the other hand, it significantly improves contrast sensitivity as well as decreasing glare and/or halo effects. Most multifocal diffractive IOLs essentially have bifocal optics that distribute light for far and near, but not for intermediate foci. The FineVision IOL combines the best of progressive refractive and diffractive bifocal technology to provide good near and distance acuity, but also dedicates light to intermediate foci and reduces loss of light due to unique appodization. These new approaches to presbyopia-correcting IOLs technology have important practical significance and broad application prospects for presbyopia. However, it is difficult for a small company to get licensed in the U.S. In order to do this, finding a collaborator is the best alternative for the small ones. Presbyopia-correcting IOLs offer important benefits to many patients, but be aware that they are associated with several disadvantages: they cause glare and halos, long-term complications, various technical challenges during subsequent vitreoretinal surgery, and so on. Further evidence and multicenter clinical trials will be necessary to corroborate the effects of the new lens. All the same, avoid excessive promotion or “selling” of refractive IOLs to reduce excessively high patient expectations. Presbyopia-correcting IOLs should be used with caution in patients with significant risk factors for age-related macular degeneration, retinal detachment, and other diseases requiring vitreoretinal surgery. Don’t just select a single type of refractive IOL as a “one size fits all” lens. We must cut their coats according to their cloth. I am hopeful that more effective products will be approved by the FDA before long. Editors’ note: Prof. Guo is a consultant for Alcon and B+L, but has no financial interests related to his comments. FluidVision is about to enter clinical trials in Germany and will hopefully garner a CE mark in the near future. From there, it’s on to the U.S. for FDA approval. But despite the years-long road ahead before the device reaches U.S. soil, Drs. Masket and Nichamin are confident FluidVision will soon be a functional, beneficial IOL. “We’re looking for a lens that would match the expectations of both the profession and our patients,” said Dr. Masket. “There’s no question that the patient base and profession want a true accommodating lens in order to continued on page 33