FEATURE EWAP MARCH 2023 9 two points that are clear, while the Vivity provides more range for each eye. The Light Adjustable Lens is the most accurate both for distance and for near, which is the harder eye to target,” he said. Dr. Kugler said he also uses the LAL as his “go-to option” for monovision in patients who have had previous corneal refractive surgery. He said some of his blended vision patients receive a monofocal lens in the dominant eye and an EDOF or trifocal in the non-dominant eye. “It’s a different kind of blended vision but it has a very high satisfaction rate in the right patients,” he said. Dr. Kugler added that the IC-8 Apthera IOL will be useful in some monovision cases. “If you’ve got a case where you want to avoid multifocality, but you want to give them a nice range of vision, it allows you to do that without the downsides of multifocality and without the limited range of vision that a fixed monofocal has. I think it fills an interesting niche,” Dr. Kugler said. Assessing candidates Dr. Donnenfeld said he employs monovision because any residual dysphotopsias that might occur can be solved with a pair of glasses and because it preserves distance vision. Trifocals, Dr. Donnenfeld continued, come with a little bit of distance vision compromise. “For patients who say they want to reduce their dependence on glasses and wear them infrequently, I want to be able to not have dysphotopsias, or if they’re not a great candidate for a trifocal… they can still be a good The IC-8 Apthera IOL. Source: Eric Donnenfeld, MD Presbyopia eye drops in development The IC-8 Apthera IOL was approved by the FDA in July 2022. When EyeWorld spoke with Dr. Donnenfeld, Dr. Kugler, and Dr. Lee, it was not yet available commercially in the U.S., but they shared their insights on how this IOL would benefit patients with EDOF capabilities as well as some therapeutic uses. Dr. Donnenfeld noted that the IC-8 Apthera was approved as an EDOF IOL. “It was approved on virgin eyes that had good visual potential, and the patients did very well in the FDA trials. The nice part about the lens is it doesn’t split light. It’s a true EDOF lens. It gives dramatically more near than the Vivity, Eyhance, and RayOne EMV, so it gives patients that extra near that they want, and it doesn’t compromise distance. In fact, it very commonly improves distance. I think there is a significant opportunity to add this lens to your portfolio. I think it’s a good consideration for people who want monovision. You will get more reading from this lens than you will from the other EDOF lenses that we generally think about.” The biggest opportunity, however, that he and other physicians consider for the IC-8 Apthera is in irregular corneas. “I think this will be one of the more important new technologies that we add to our armamentarium for the most challenging patients in our practice. This lens is going to solve problems that previously were unsolvable for many patients,” Dr. Donnenfeld said. Dr. Lee, who participated in the clinical trials for the IC-8 Apthera, said that the lens will be helpful for monovision, even when set for –0.75 to –1 D, but he is also looking forward to its use for irregular corneas. “Additionally, the IC-8 Apthera will allow for continued RGP wear for patients, unlike a toric IOL or Light Adjustable Lens. Irregular corneas will be an off-label use because those patients were excluded from the trial, so I expect that surgeons will start using it and see how their patients do, just as with any new technology. However, it will be important for us to have reasonable expectations for the IOL because it would be unfair to expect miraculous results in abnormal, highly aberrated eyes,” Dr. Lee said. Dr. Kugler, also an investigator in the IC-8 Apthera trial, said this lens might be attractive for surgeons who have been hesitant to offer multifocals due to the management or enhancement needed for them. “For cataract surgeons who don’t have access or capability to enhance those patients, multifocals are very difficult to use successfully. You tend to get frustrated with them and stop offering them. I think that’s a huge complexity to multifocal IOLs, whereas the IC-8 Apthera is very forgiving. The enhancement rate is not zero but it’s lower than what you would have with a multifocal,” Dr. Kugler said. He noted that while he doesn’t have experience with post-refractive eyes and the IC-8 Apthera, if you look at the work of international ophthalmologists, the IC-8 Apthera is a common solution for post-refractive eyes. “I do wonder how it’s going to fit into what we’re doing for post-refractive IOLs. The Light Adjustable Lens is great, but it also has its downsides,” Dr. Kugler said, adding that looking at international experience, he thinks it will be an especially good option for post-RK eyes. IC-8 Apthera makes U.S. but
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