35th APACRS LIM Lecture: Current and Future Development in Intraocular Implants with New Materials by Christina Chintanaphol Singapore – The highly anticipated Lim Lecture of the 35th APACRS Singapore was delivered by Gerd U. Auffarth, MD, during the Opening Ceremony. “Giving the Lim Lecture is something really special. Dr. Lim is iconic in the APAC region, especially in Singapore, and it is a huge honor for me to deliver this lecture,” Dr. Auffarth remarked, whose lecture was “Current and Future Developments in Intraocular Implants with New Materials.” Dr. Auffarth said the basic treatment of cataracts has advanced thanks to the many types of intraocular lenses (IOLs) currently available. Today, in 2023, ophthalmologists are seeing different optical principles being utilized in IOLs such as diffractive optics, refractive optics, and the newer high aspheric optics. “There are so many different types of lenses, and nobody really knows which model is the best, and what model we should use,” Dr. Auffarth said. In fact, “some categories don’t have a true definition.” For example, different types of presbyopia-correcting IOLs overlap in terms of what they can achieve but also differ in terms of their optics. Will we be able to get to the point where we are completely spectacle independent? Dr. Auffarth emphasized “there is no free lunch in optics. You can’t get everything without paying for it.” Different monofocal IOLs have been developed with different characteristics in mind: higher order aspheric components, induced positive spherical aberrations, and hydrophobic properties with 4 diffractive rings, to name a few. Dr. Auffarth warned against going “too far” with these special characteristics, as more problems can crop up such as point spread function, halo, and depth of focus issues. Dr. Auffarth also described new concepts based on current technology. Binocular trifocality and reversible trifocality have been introduced in different complementary IOL systems such as the Artis Symbiose® (Cristalens) and Sulcoflex Trifocal (Rayner). IOLs with phase continuity may provide relief to patients who experience blurred visual quality by way of phase inversion. Neuroadaptation to new optics is yet another patient aspect ophthalmologists may need to consider. One novel IOL material that may be of high interest is crosslinked polyisobutylene (xPIB), which has shown biocompatibility with no glistening nor inflammatory response. Ultimately, “accommodative and adjustable IOL technology will be the future,” Dr. Auffarth said. To name a few, the ophthalmology world has already developed lenses containing macromers that turn into polymers when exposed to ultraviolet light, using a laser beam to change refractive power (two-photon chemistry), pulsing femtosecond lasers to adjust lenses, and using split lens solutions. An abundance of technology promises endless possibilities for patients undergoing cataract and refractive surgery, he said. EWAP
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