EyeWorld Asia-Pacific September 2013 Issue

44 EWAP CAtArACt/IOL September 2013 The FluidVision lens Source: PowerVision The Sapphire Autofocal IOL, an electromechanical lens, can potentially provide patients with a full range of vision. Source: Eric D. Donnenfeld, MD Eyeing accommodative and multifocal IOLs in the pipeline by Maxine Lipner EyeWorld Senior Contributing Writer Continued quest for full range of presbyopic vision W hile options have grown among accommodative and multifocal lenses, so far no perfect replacement for the young natural lens exists. “It remains the Holy Grail,” said Louis D. “Skip” Nichamin, MD , medical director, Laurel Eye Clinic, Brookville, Pa., USA. “I think that it is the most sought- after technology that we currently don’t have.” Yet new technologies such as innovative multifocal lenses available outside of the U.S. as well as unique accommodative approaches still in prototype are moving the prospect closer. There would be a huge market for such a lens that truly mimics human accommodation, said Eric D. Donnenfeld, MD , professor of ophthalmology, New York University, New York, NY, USA. “Accommodative and multifocal lenses right now constitute about 7% of all cataract surgeries done in the United States, and that’s with lenses that are good but not great,” Dr. Donnenfeld said. “If we could come up with a lens that was significantly better, that reduced side effects and had reproducible excellent reading vision, the demand for that lens would be almost limitless.” Indeed, despite available options, the need remains. Unhappy with current lenses, Michael Lawless, MD , Vision Eye Institute, Chatswood, New South Wales, Australia, has currently stepped back from the accommodative market altogether. “I used the Crystalens HD [Bausch + Lomb, Rochester, NY, USA] for two years from 2009 to 2011 and stopped using it because the enhanced reading available with this lens was minimal in my hands, giving an effect of approximately 0.75 diopters,” he said. “This was outweighed by the fact that the YAG capsulotomy rate was very high, at 75% in my cases.” Likewise, he does not use other accommodative lenses since he has not found them to be an improvement over the Crystalens. Dr. Lawless does, however, use multifocal lenses in about 35% of patients. He relies on ingenuity to bring patients the full range AT A GLANCE • The Lentis Mplus lens uses a new approach to attain multifocality and is visually forgiving. • An innovative trifocal, the AT LISA tri 839MP, offers patients computer range as well as near vision. • The FluidVision Lens, which is filled with ophthalmic-grade silicone oil, has been known to attain up to 5 D of accommodation. • A new electromechanical lens in prototype, the Sapphire, works independently of the muscles and is not constrained by capsular bag hardening.