EyeWorld Asia-Pacific March 2015 Issue

36 EWAP CATARACT/IOL March 2015 Extracapsular - from page 32 New - from page 35 Moran Eye Center. Monocular implantation provided a “continuous, broad range of vision resulting in excellent visual acuity across all distances,” although results were in only 11 patients andonly through 6 months of follow-up. For now, the “holy grail” of true accommodation in an artificial lens does not exist—but Dr. Mamalis is optimistic that with the new technologies being developed here and overseas, it’s only a matter of time. Extended range of vision lens There is “pretty good data” from European studies on the Tecnis Symfony IOL (Abbott Medical Optics, Abbott Park, Ill.), “including defocus curves that show about 1 D of accommodation, which is similar to the Crystalens or Trulign [both Bausch + Lomb, Bridgewater, NJ],” said Mark Packer, MD , president of Mark Packer MD Consulting. But the Tecnis’ mechanism of action “is much more conventional,” as it is a single diffractive. “It’s as if you took a multifocal lens and eliminated all the rings except one,” he said. By manipulating the echelette, AMO “can get a defocus curve that’s fairly flat from infinity in, to about 1 m.” The Symfony “may be a step in the right direction,” but may not give patients a wide enough amplitude of accommodation, said Dr. Mamalis, who thinks a “totally different design” will be needed. “[It may be] a dual optic lens or a lens that changes the shape of the optic when you accommodate with a material, like silicone in the middle of it. That’s going to be the future,” Dr. Mamalis said. Dr. Packer said distance and intermediate “will be equivalent and greater” than current lenses, but people with these lenses “will still need a lower-powered pair of reading glasses.” However, the elimination of halos may be worth that trade-off, he said. The lens may be “much more forgiving in terms of distance vision,” meaning someone who is “almost 1 D hyperopic post- surgery will still have clear distance vision,” Dr. Packer said, although that person would lose intermediate vision. “In that example, the lens would function more like a monofocal, but you have a whole diopter of pretty much flat defocus curve. It’ll be more forgiving in terms of the IOL power calculation for distance,” he said. EWAP Editors’ note: Drs. Alio, Mamalis, Packer, and Werner have financial interests related to their comments. Dr. Cummings has no financial interests related to his comments. Contact information Alio: jlalio@vissum.com Cummings: abc@wellingtoneyeclinic.com Mamalis: nick.mamalis@hsc.utah.edu Packer: mark@markpackerconsulting.com Werner: liliana.werner@hsc.utah.edu anterior chamber lenses, which have usually been related to older closed-loop lenses or newer lenses that have not been appropriately sized. “With the modern, Kelman- style open-loop IOLs that are appropriately sized, the complications are fairly few,” he said. He also offered pearls to the audience for suturing PCIOLs to the sclera, such as using 9-0 prolene or CV-8 Gore-Tex instead of 10-0 prolene because it can break. When choosing fixation points, surgeons should avoid the 9 o’clock and 3 o’clock positions, he said. Most surgeons are now performing 4-point fixation rather than 2-point fixation, he said, but both are valid techniques for scleral fixation. The glued IOL technique was originally developed by Gabor Scharioth, MD , and more recently popularized by Amar Agarwal, MD . Also known as the intrascleral haptic technique, in this method the haptics are buried within the sclera and fibrin glue is used to hold down the conjunctiva and scleral flaps, Dr. Hoffman explained. While the procedure is fairly new, 5-year follow-up of patients with glued IOLs has shown that the haptics are not extruding out of or into the eye as Dr. Hoffman had feared, but longer follow-up is still needed. “I’m fairly confident that the intrascleral haptic technique will probably be found to be safe in the long run,” he said. Dr. Hoffman also cited several recent studies that have investigated the outcomes associated with anterior chamber lenses versus posterior chamber lenses. All concluded that there were no significant differences in outcomes between the two types of lenses, he said. Because each case is different and a myriad of complications can arise, the most important concept to understand is that “all of the techniques are valid, and none has been shown to be superior to another one,” Dr. Hoffman said. “There are situations where you might have to perform iris fixation or scleral fixation, and you should be familiar with all of the techniques.” EWAP Editors’ note: Dr. Hoffman has no financial interests related to this article. Contact information Hoffman: rshoffman@finemd.com