REFRACTIVE EWAP DECEMBER 2023 39 so it is often prudent to do the surgery on axis to reduce the astigmatism. In terms of technique and implantation of the lens, Dr. Bafna said the process is straightforward. There is an injector approved for use with the lens. He also mentioned the larger incision that might be needed with the IC-8 Apthera to avoid too tight of a fold that could damage the filter. Dr. Williamson said he often uses a 2.5-mm incision during surgery but uses a larger one for the IC-8 Apthera. “What a lot of people won’t appreciate is it has to go through a 3-mm incision,” he said. “If I’m doing an on-label patient, I will typically use a 3-mm blade, larger sleeve, and surgery is the same. You just don’t want to try to use a 2.4-mm sleeve in a 3-mm wound. It leaks and makes the surgery that much harder.” Future advances In terms of future developments, Dr. Cummings said he would like to have a pre-loaded version of the IOL and a toric version. Often these aberrated corneas have significant amounts of astigmatism, he said. Dr. Bafna said he’d be interested in seeing different aperture sizes for the lens in the future. Right now, it’s one size fits all, but depending on the individual and based on what their pupil size is and how much irregularity they have in the cornea, he would want the surgeon to have options to choose lenses with different size openings. However, he noted that the current opening works well for the majority of patients. Dr. Stonecipher stressed that the IC-8 Apthera is another great tool in the toolbox, and he doesn’t want to pigeonhole it in the complex corneas. “I think it’s got an array of options available in the big picture. I find patients in whom I thought they would need something additional, and it’s amazing how the pinhole effect makes a difference,” he said. EWAP Editors’ note: Dr. Bafna practices at Cleveland Eye Clinic, Brecksville, Ohio, and has interests with Bausch + Lomb. Dr. Cummings is Medical Director, Wellington Eye Clinic, Dublin, Ireland, and has interests with Alcon, Bynocs, NanoDrops, REVAI, Scope, TearLab, and Vivior. Dr. Stonecipher is Clinical Professor of Ophthalmology, University of North Carolina; Clinical Adjunct Professor of Ophthalmology, Tulane University, Greensboro, North Carolina; and has interests with Alcon, Bausch + Lomb, Johnson & Johnson Vision, and Rayner. Dr. Williamson practices at Williamson Eye Center, Baton Rouge, Louisiana, and has interests with Bausch + Lomb. Yeo Tun Kuan, MD Senior Consultant, Department of Ophthalmology, Tan Tock Seng Hospital 11 Jalan Tan Tock Seng, Singapore 308433 tun_kuan_yeo@ttsh.com.sg T he Apthera IC-8 (Bausch & Lomb) is a new intraocular lens (IOL) that utilizes small aperture optics via a central opaque ring. Initially approved as an extended depth of focus IOL and for correction of corneal astigmatism up to 1.5 D, it has found new roles and functions. The small aperture optics can be harnessed in eyes with complex corneas as it filters out undesirable peripheral light. Complex corneas include those with irregular astigmatism and high higher order aberrations (HOAs) that degrade visual quality. Keratoconus, decentered laser ablation with coma, radial keratotomy and previous penetrating keratoplasty are potential conditions that can benefit from the IC-8. Highly irregular astigmatism cannot be corrected adequately by a toric IOL, and the IC-8 offers an intraocular lens-based solution for such patients. Similarly for eyes with high HOAs, the IC-8 is able to reduce the impact of the corneal aberrations on visual acuity, and at the same time, provide some extended depth of focus. This is definitely a very useful addition to our armamentarium when previously we would only have the option of a monofocal IOL in these eyes. When using the IC-8 as an extended depth of focus (EDOF) IOL, it is implanted in the non-dominant eye with a target refraction of about -1D. It is an alternative to traditional monovision and other presbyopia correcting IOLs. Patient selection and counselling remain important, whether the IC-8 is used as an EDOF IOL or for the correction of irregular astigmatism and HOAs. As the IOL filters out some light, it is important to inform the patient that since less light enters the eye, things may appear dimmer. For patients with less significant cataracts, this can be simulated with Pilocarpine eyedrops, to gauge patient acceptability. Vocational or frequent night drivers therefore may not be suitable candidates. It is also important to examine the mesopic pupil size of the patient, as too large a pupil can potentially lead to haloes at night. Finally, for eyes with complex corneas, aberrometry is useful a diagnostic tool in determining the amount of HOAs and simulate whether a smaller pupil size would improve visual quality. The Apthera IC-8 is a welcomed IOL that provides us with greater options especially in eyes with complex corneas. I can see more of these patients benefiting from this IOL. Editors’ note: Dr. Yeo disclosed no relevant financial interests. ASIA-PACIFIC PERSPECTIVES
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