EyeWorld Asia-Pacific June 2021 Issue

CATARACT EWAP JUNE 2021 21 enhancement rate. For a small group of patients and those who really desire accurate outcomes, he said it is a good option. Accommodative The IOL holy grail is a lens that functions like an emmetropic 20-year-old’s with accommodative abilities. While much work is being done toward this goal, nothing has quite met the mark. “I think aside from tuning the distance vision perfectly, being able to have that smooth transition from distance to near that happens with your intention to focus at different distances would be fabulous,” Dr. McCabe said. “I think there are many great ideas being put forward. There [are] just always challenges and compromises that come with these designs. I don’t know what will rise to the top of this, but I think we want to continue to innovate in those areas.” There are many different approaches being looked at. Juvene (LensGen) is a two-part IOL that works off a biomimetic principle to shift fluid to direct accommodation, Dr. Donnenfeld said, adding that data shows the majority of patients achieve 20/20 or better at distance, 20/25 at intermediate, and 20/40 at near. There are a number of other accommodative IOLs at different stages of development. FluidVision (Alcon) is an IOL that uses the ciliary body’s existing accommodation to move fluid in and out of different areas of the IOL. Tek-Clear Accommodative Lens (Tekia) also takes advantage of the eye’s ciliary body with a haptic-optic design that bends with this muscle movement. Tekia calls this a “bending-beam” approach. ForSight Labs is creating Opira, which according to a company presentation at the 2019 Ophthalmology Innovation Summit, is a sulcus-based lens with haptics fixated in the capsulorhexis that uses the ciliary body to create a “dynamic anterior surface.” Lumina (AkkoLens) is composed of two progressive, flexible optics and is fixated in the ciliary muscle. The company stated that the amount of accommodation achievable depends on the existing strength of the ciliary muscle. Atia Vision Modular Presbyopia Correcting IOL (Atia Vision) has a stationary refractive optic and an accommodative base that is driven by the ciliary muscle. TetraflexHD (Lenstec) is approved outside of the U.S. and features a slightly angled lens with haptics that flex as the ciliary muscle moves. In a departure from accommodating IOLs that work with the existing ciliary muscle, Alcon is working with Verily, a subsidiary of the Google-connected Alphabet, to develop an electronically driven IOL. Finally, Crystalens (Bausch + Lomb), which is approved in the U.S., was among the first in the category of accommodative IOLs to make it to market. Dr. Cummings said he thinks accommodating IOLs will make it to the market, but he admitted that it will take some time. “Will they replace all IOLs? I don’t think so. It depends on the cost, size of the lens, how easy it is to insert the lens. I think the biggest challenge to accommodating IOLs is how well the other [advanced technology] IOLs have come along. … You’ll have to go over and above with an accommodating lens to justify.” New materials While companies are constantly working on IOL innovations, one area that doesn’t see change very often is IOL material. One recent innovation that has been getting attention by ophthalmologists on the material front is Clareon (Alcon, not yet available in the U.S.). Dr. Cummings described the Clareon material as “pristine” with no glistenings. “I think it surprised everyone how good this lens is. Everyone I know who is using it loves it. I think it’s the highest quality lens that Alcon has produced,” he said. More preloaded IOLs There has also been a push for more preloaded IOLs. Clareon, for example, comes as a preloaded IOL with the company’s AutonoMe delivery system. AutonoMe is an automated (gas-driven), single- use IOL delivery system. “You’ve got amazing control of the delivery,” Dr. Cummings said of the system, adding that the Clareon material coupled with this delivery system makes it “the nicest lens I’ve used.” Most other major IOL manufacturers have been adding to their portfolio of preloaded IOLs in recent years as well. Dr. Donnenfeld said preloaded IOLs have an added level of stability and safety and make it easier on staff to transfer the lens to the surgeon. The quality and ease of the inserter, according to Dr. Cummings, can be an influential factor in use of the IOL. “In other parts of the world, I’ve heard of surgeons switching to a particular brand of IOL because the range has the same inserter. … Once you find an inserter that works well for you, it’s easier, more repeatable,” Dr. Cummings said. Despite updates in the IOL market to improve range of