EyeWorld Asia-Pacific December 2014 Issue

December 2014 24 EWAP SECONDARY FEATURE The AkkoLens accommodating IOL uses the ciliary muscle to move sliding aspheric surfaces laterally. Source: AkkoLens International meaning it’s using the movement of fluid, and in the periphery it has what looks like a big inner tube,” he said. “As the eye accommodates, that peripheral inner tube with fluid is compressed, and the fluid is moved through channels centrally and pushes against a very flexible membrane. That can cause meaningful accommodation to occur.” Future of presbyopia correction? Dr. Gatinel thinks that corneal inlays, laser refractive surgery, and IOL surgery all have potential to play a significant role in the future of presbyopia correction. “Surgeons should improve the quality of patient selection to better match a specific treatment modality to the patient’s visual expectations,” he said. “Based on the preoperative refraction, the level of crystalline lens opacification, the pupil dynamics, and the pre-existing level of corneal multifocality, it should appear that some techniques are more suitable than others in a particular eye or patient.” In his work, Dr. Gatinel has found that multifocal IOLs are well tolerated by patients who have a cataract. “When the lens is clear, inlays or laser refractive surgery may be a safer option,” he said. Additionally, he added that multifocal laser ablations and inlays might be best for hyperopes, while monovision is a better option for myopes. “In many cases, these corneal strategies incur a mixture of monovision and multifocality, where the dominant eye is less multifocal and close to emmetropia, and the nondominant eye more multifocal and closer to myopia,” Dr. Gatinel said. Elenza and other electronic systems Although Elenza (Roanoke, Va., U.S.) was previously developing an electronic lens, Dr. Lindstrom said the project is stalled, and the company is not currently active as it failed to capitalize on its business plan. The company had made significant progress in developing the technologies that would be necessary to create an electronic intraocular lens that would change powers, including tiny rechargeable batteries. Dr. Lindstrom said a positive note may be the recent joint venture by Alcon (Fort Worth, Texas, U.S.) and Google (Mountain View, Calif., U.S.) to develop an electronic contact lens. Some proposed features of this are diagnostics to measure blood sugar and an ability to create a contact lens that is similar in idea and structure to what Elenza was doing. Another stalled electronic lens system is the eyeglasses from PixelOptics (Roanoke, Va., U.S.) that had the ability to change power; however, this company also failed. Dr. Lindstrom hopes for development of electronic lens projects in the future. Additional points Although multifocal technology is progressing, Dr. Gatinel still finds that the level of customization that is put into monofocal corrections with wavefront laser-based refractive surgery is not always used for multifocals. “Preoperative wavefront (both corneal and total) measurements along with pupil dynamics exploration should be part of the preoperative exploration of patients interested in presbyopia correction,” he said. Meanwhile, Dr. Lindstrom said there are new IOLs that could be introduced sooner than we think. The next IOLs that will be seen are extended depth of focus lenses, he said. He expects these to be introduced in the U.S. at about the same time as the rest of the world. “These lenses use either aspheric optics, so they’re hyper aspheric, or hyper prolate optics to increase the depth of focus of the intraocular lens,” he said. “That allows good distance and good intermediate vision with some near, with almost imperceptible loss of quality at distance and minimal night vision symptoms.” Dr. Lindstrom said this technology will likely launch first from Hoya (Tokyo, Japan), with Alcon and Abbott Medical Optics (AMO, Santa Ana, Calif., U.S.) getting involved as well. EWAP Editors’ note: Dr. Lindstrom has financial interests with Alcon, AMO, and Bausch + Lomb (Bridgewater, NJ, U.S.). Dr. Gatinel has financial interests with PhysIOL. Contact information Gatinel: gatinel@gmail.com Lindstrom: rllindstrom@mneye.com Future - from page 23