EyeWorld Asia-Pacific September 2015 Issue

18 September 2015 EWAP FEATURE Views from Asia-Paci c Myoung Joon KIM, MD Associate Professor Asan Medical Center 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736 Tel. no. +82-2-3010-3975 Fax no. +82-2-470-6440 mjmjkim@gmail.com R ecently, there has been growing interest in presbyopia-correcting IOLs (PC-IOLs) among ophthalmologists. Many surgeons are using multifocal IOLs for correcting presbyopia when they treat cataract. Clearly, multifocal IOLs are not a perfect choice in many of the cases. Patients often complain about halo, glare, and unsatisfactory intermediate vision and/or near vision. The “truly accommodative IOL” could be another hopeful choice as Dr. Hoffman said; however, it would require a breakthrough in research and development. As an advancement of diverse technologies, IOLs with totally new functions may become available in the coming years. For example, a certain material which can contain drug molecules and release them in certain circumstances may be developed. If we use that material for making IOLs, we may not need to prescribe eyedrops postoperatively to patients, as Dr. MacDonald thinks. But there must be a support of materials engineering. Moreover, we have already heard news about some kind of “smart contact lenses” using cutting-edge information technology. I anticipate that it will be commercialized and adapted to other optical devices including IOLs in a few years. Including IOLs, I expect a more customized cataract surgery in the future. Many kinds of IOLs are available in these days—toric IOLs for astigmatism, aspheric and IOLs for different corneal spherical aberrations, tinted IOLs for speci c patients, and so on. So we can provide more suitable options for each patient than we were able to a decade ago. Patients have all different corneal shapes and optical/neural status. Neural adaptation to pre/postoperative vision would not be the same for each patient, which cannot be evaluated objectively at present. If we are able to understand and manage these factors more delicately, we can expect to reach perfect outcome after cataract surgery. Editors’ note: Prof. Kim has no nancial interests related to his comments. Samaresh SRIVASTAVA, MD Consultant Raghudeep Eye Hospital A-16 Shanti Path, Tilak Nagar, Jaipur, India Tel. no. +91-141-4043901/9099026161 samaresh@raghudeepeyeclinic.com I agree with both authors that IOL technology is improving in leaps and bounds and holds a lot of promise for the future. Technologies like accommodative IOLs, light adjustable IOLs, and even customized lenses based on patients’ ocular aberrations seem to be the way forward. Further, IOLs with artificial intelligence which are able to autofocus at all distances, if they become a commercial reality, will change the whole game. However, in the future, two other areas that I see emerging are the use of femtosecond lasers and the use of non-surgical methods to deal with lens disorders. Based on ongoing research, there is some promise that lasers may be used to selectively treat lenticular fibers so accommodation can be restored. Femtosecond lasers are already being widely used in cataract surgery, and with time, as the technology improves, precision and safety in cataract surgery will increase dramatically. However, at present, the cost of the technology and reimbursement issues for patients are a worldwide limitation. There has also been ongoing research on the use of drugs such as lanosterol that seem to be able to shrink cataracts by affecting the lens protein metabolism. As was recently published in Nature, this drug may be able to at least stabilize progressive cataracts. Studies are also being conducted to prevent the incidence of cataract using gene therapy. The aim of these techniques is to identify the gene(s) responsible for keeping the integrity of the normal crystalline lens proteins in order to develop drugs capable of preserving this/these gene(s) from the alteration in composition that occur with aging, ultimately leading to prevention of the incidence of cataract. To summarize, I feel that customized outcomes, using IOLs to suit the particular patient and the particular eye, and using technology to assist the surgeons is the way forward. The emphasis will be more and more on refining technical and visual outcomes. Editors’ note: Dr. Samaresh has no relevant financial interests. continue on page 22 The future - from page 17