EyeWorld Asia-Pacific June 2018 issue

June 2018 EWAP FEATURE 27 Views from Asia-Pacific Shail Abhaykumar VASAVADA, MD Consultant, Raghudeep Eye Hospital Nr. Shreeji Complex, Gurukul Road, Memnagar, Ahmed- abad 380052, India Tel. no. +91-79-27490909 shail@raghudeepeyeclinic.com T he wait for the perfect IOL goes on! There have been several new IOLs that have come up in the last 5–7 years, some are modifications of existing platforms, and some newer platforms. Currently, we are picking and choosing one lens or one technology over the other on a patient to patient basis, trying to give them the quality of lifestyle and visual requirement they require. The present armamentarium for most surgeons is to choose from a range of monofocal, bifocal, and trifocal IOls (toric or otherwise). There is no true EDOF IOL available, and the so-called EDOF IOLs are nothing but variations of low add power bifocal lenses. Technology for monofocal IOLs is as good as we could expect today; however, it is the pressing problem of presbyopia correction which still remains the real challenge to answer. “ Currently, we are picking and choosing one lens or one technology over the other on a patient to patient basis, trying to give them the quality of life- style and visual requirement they require. The present armamentariumformost surgeons is to choose from a range of monofocal, bifocal, and trifocal IOLs (toric or otherwise). ” - Shail Abhaykumar Vasavada, MD Out of the several new promising IOLs, the accommodating IOL category has always generated the most buzz amongst surgeons. The current two models being tried, Juvene and FluidVison, have the limitation of a bulky design (require larger incision and rhexis), difficult implantation (removing them would be a nightmare), and possibility of fluid/silicone leak due to any potential damage to the IOL. Further, achieving emetropia and treating PCO with these IOLs remains a major challenge. The principle that excites me the most is the adjustable IOLs (Light Adjustable and Femtosecond Adjustable). Although at this current time they have significant practical and logistic limitations for wider application, it would be great to be able to modify the IOL type/refractive error based on how good or how bad the patient feels with what we have put in his eye. For the foreseeable future, most cataract surgeons will be limited to choose from the “standard” monofocal, bifocal or trifocal lenses, very well accepting the limitations of each one. All of us should try and tailor the choice of the existing IOLs based on the patient’s visual demands, catering a “Made for You” approach, as there is no one fix size that fits all. The wait for the perfect IOL goes on! Editors’ note: Dr. Vasavada declared no relevant financial interests. Masket said. The CE-marked Masket ND IOL Type 90s (Morcher) is designed with a groove to accept the ante- rior capsulotomy for placement. To date, there have been no cases of negative dysphotopsia in patients with this lens, Dr. Masket said. According to him, the lens is universal. It has haptics if the cap- sulotomy ends up being unsuitable for capsulotomy fixation (incom- plete, wrong size, decentered) or it can accommodate sulcus fixation as well. It can be made in a multi- focal or toric fashion. In addition, to the Masket ND IOL, there are two other capsul- otomy fixated IOLs—Femtis Laser Lens (Oculentis, Berlin, Germany) and bag-in-the-lens (BIL, Morcher). There are “countless advantages” to a capsulotomy fixated IOL, Dr. Masket said, among them being negative dysphotopsia prevention, axial and rotational stability of to- ric IOLs, limited tilt, avoidance of capsule contraction, more predict- able ELP, and reduced higher order aberrations. Other IOL design improve- ments that others are working on, which Dr. Masket called “pipe dreams”— he’s not convinced they’re needed —are ones that would allow for an even smaller in- cision size and polymers that could refill the existing capsular bag. Dr. Lindstrom said he would like to see an IOL that prevents posterior capsule opacification among the design or material modifications made in the future. Currently, Dr. Devgan said, there is no perfect lens on the market. “Every lens has some great upsides and some significant downsides,” he said. “We have to balance that and match that to the appropriate patients. Patient happi- ness is the difference between the results that we get and what their expectations were. Certainly, we want to maximize our results, but also we need to be smart; we need to temper our patients’ expecta- tions.” EWAP References 1. Pepose JS, et al. Benefits and barriers of accommodating intraocular lenses. Curr Opin Ophthalmol. 2017;28:3–8. 2. Werner L, et al. Biocompatibility of intraocular lens power adjustment using a femtosecond laser in a rabbit model. J Cataract Refract Surg. 2017;43:1100– 1106. Editors’ note: Dr. Devgan has financial interests with LensGen. Dr. Lindstrom has financial interest with Alcon (Fort Worth, Texas), Bausch + Lomb, Johnson & Johnson Vision (Santa Ana, California), and Carl Zeiss Meditec (Jena, Germany). Dr. Masket has financial interests with Morcher and PowerVision. Contact information Devgan: devgan@gmail.com Lindstrom: rllindstrom@mneye.com Masket: avcmasket@aol.com