REFRACTIVE 36 EWAP DECEMBER 2023 This article originally appeared in the September 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Bafna: sbafna@midwestvision.com Cummings: abc@wellingtoneyeclinic.com Stonecipher: stonenc@gmail.com Williamson: blakewilliamson@weceye.com T he IC-8 Apthera IOL (Bausch + Lomb) is now available in the U.S., and several surgeons shared how this technology fits into their practice and for which patients. Arthur Cummings, MD, also provided an international perspective. Shamik Bafna, MD, who was involved in the FDA clinical trial, said that this lens works well in any patient who has an irregular cornea, especially irregular astigmatism like that seen in keratoconus. However, in the clinical trial, the lens was not used in patients with irregular corneas. In these cases, the cornea is limiting the quality of vision. A toric lens can correct regular, Incorporating the IC-8 Apthera into practice by Ellen Stodola Editorial Co - Director symmetrical astigmatism, “but in an irregular cornea, we don’t have a custom toric lens where it has less astigmatism correction on one side and more on the other. In the past, prior to approval of the IC-8 Apthera, we would attempt to use a toric lens in these [cases], and it would be hit or miss,” he said. “The other factor is if someone was used to wearing a gas permeable contact lens, we would not use a toric contact lens because it would make fitting of the gas permeable contact lens more challenging.” The IC-8 Apthera works well for patients who have an irregular cornea because it has a filter that blocks all of the peripheral light rays, so it only allows the central light rays to come through. In a cornea that has irregularity, it’s hard to focus with all of the light rays peripherally, so this allows the central light rays that don’t have irregularity to focus directly on the retina. “If someone has keratoconus, if you put in the IC-8 Apthera lens that has a filter, we’re only allowing the clean, central light rays to go through,” he said. “This is the most common case in which it’s used, but it’s something we’re using off label because we know from our colleagues in Europe that it works well in this situation.” The lens has been FDA approved to correct astigmatism up to 1.5 D, which Dr. Bafna said helps to correct a range of vision by using small aperture optics. He likened it to an EDOF lens, more so than a multifocal that splits light. It increases the overall depth of field and increases the overall range of focus, he said. Extended range of focus is what the IC-8 Apthera is currently FDA approved for, placed in the non-dominant eye. While keratoconus is the most common reason for using this lens off label for irregular astigmatism, Dr. Bafna said things like Salzmann’s nodules and pellucid marginal degeneration can create an irregular amount of astigmatism. Patients with prior RK are also likely to have some irregularity in their cornea. “What’s hard with RK is there’s a lot more variability Figure 1. Right eye macular OCT through the IC-8 Apthera in a patient with bilateral IC-8 Apthera IOLs who is very happy with the outcome and totally spectacle independent.
RkJQdWJsaXNoZXIy Njk2NTg0