EyeWorld Asia-Pacific September 2019 Issue

FEATURE 14 EWAP SEPTEMBER 2019 Dr. Weinstock performs heads-up 3D cataract surgery with the NGENUITY system. Source: Robert Weinstock, MD ORA is also particularly helpful for post-refractive cases,” she said. “I have become much more aggressive with astigmatism correction over the past decade, especially with regard to the correction of against-the-rule astigmatism,” subsequently improving refractive outcomes overall. Postoperative adjustments One way to hit refractive targets and achieve optimal outcomes is to broaden the range of focus, reducing the need for pinpoint accuracy. Dr. Lee mentioned the AcuFocus IC-8 (AcuFocus), a pinhole monofocal implant undergoing a clinical trial that he said “should provide some range of vision without the type of night symptoms that current MFIOLs and the Symfony [Tecnis extended depth of focus IOL, Johnson & Johnson Vision] cause.” All the doctors look forward to technologies that will allow them to modify sphere and cylinder postoperatively, hitting their targets after the fact. “This will be a huge advantage to cataract and refractive surgeons alike, as they are now able to easily make adjustments and enhancements to patients postoperatively without an additional surgical procedure or intraocular lens exchange,” Dr. Weinstock said. “The promise of 20/15 vision for all patients is certainly on the horizon with technologies like this in development.” Among these technologies, the Light Adjustable Lens (RxSight), already approved by the FDA, is “the initial player in this new arena,” Dr. Donaldson said. Other technologies are forthcoming. She said there are several forms of component IOLs in development. These IOLs have exchangeable optic segments Ì >Ü `wV>Ì vÀ monofocal to multifocal and vice versa as well as adjustment to refractive error postop. “Eventually, refractive indexing will allow us to modify the refractive error with a laser postoperatively; however, we may still be several years away from implementing this technology in our everyday clinical practice,” she said. Dr. Garg described the ÕÛii yÕ`wi` iÃ (LensGen), one example of a `w>Li V«iÌ " ° According to Dr. Garg, the IOL has a modular design that employs a dual optic principle— i wÝi`] Ìi ÌiÀ yÕ`wi`p and has delivered up to 3 D of accommodation in early trials. Improving technology improves outcomes All these technologies combined “cumulatively improve cataract surgery outcomes for our patients,” Dr. Weinstock said. “[I]f you take all of these >`Û>ViÃ ÕÀ wi` >` ÕÃi them together in a process it ÌÀ>Ã>ÌiÃ Ì > Ài Àiwi`] safer, and predictable surgery and outcome for the patients.” These advances allow surgeons to be more accurate in their outcomes, and “when combined with diligent preparation of the ocular surface, refractive surprises are less apt to occur,” Dr. Garg said. Providing context for these advances, Dr. Lee noted that “history has proven the brilliance of Charles Kelman’s innovation of «>ViÕÃwV>Ì° Ì Ã ÃÌ Ìi best way to break up and remove a cataract more than 50 years after its introduction,” he said. Fortunately, surgeons “have gotten better and better at picking the correct IOL and making cataract surgery a true refractive procedure.” “The next step will be «ÀÛi` >LÌÞ Ì Àiwi outcomes after phaco and improving range of vision with fewer optical trade-offs,” he added. “[O]ur technology has allowed us to keep up with progressively increasing patient demands and