20 EyeWorld Asia-Pacific | December 2024 CATARACT “Most of my colleagues who have used the IC-8 Apthera find its utility in managing post-refractive surgery eyes, such as previous RK, PRK, LASIK,” he said. “The aberrationfiltering feature maintains or even improves distance corrected vision and quality of vision.” He added that the presbyopia capability is the bonus. Other presbyopiacorrecting IOLs using diffractive, wavefront-shaping, or spherical aberration induction optics can worsen quality of vision and photic phenomena by inducing additional aberrations. “The IC-8 Apthera is my preferred lens choice for post-refractive eyes,” Dr. Ang said. “I have used this lens in clinical studies over 8 years and commercially for 1 year.” Dr. Fram said that one of the exciting things about this concept is that the pinhole effect can also help patients with higher order aberrations (HOAs). “HOAs are the irregularities of the light rays as they hit the eye on whatever interface, and it got us thinking of some off-label use of this technology,” she said. The idea would be if you create a pinhole effect, you can reduce the higher order aberrations, Dr. Fram said “We found that there’s this whole population of patients, to whom we were saying, ‘You could get a PKP or DALK, wait a year, then do the cataract surgery and hope you don’t need a contact lens after for your best corrected vision, or we can do a monofocal lens and a scleral lens fitting.’ That was all we had to offer them, and many didn’t want to wear contacts.” Dr. Fram and colleagues presented a paper on clinical outcomes in patients with irregular corneas receiving small aperture technology at the 2024 ASCRS Annual Meeting.1 The patients studied included those who had RK, keratoconus, post-PKP, and corneal scarring outside the visual axis. Fifty complex cornea eyes were examined, and Dr. Fram said the results were impressive with patients achieving 7.2 lines of improvement in uncorrected distance visual acuity and 2.4 lines of improvement in uncorrected near distance. However, all patients were counseled that they might need scleral contact lenses even after the IC-8 Apthera technology, she said. Dr. Fram said a caveat with these patients is you need to ensure that there is no central scarring when you use the IC-8 Apthera technology. A preoperative pinhole test in the office or a pilocarpine 1% test is helpful to make sure that the dimming is acceptable to the patient. “I say, ‘One eye gets better far vision, while in the second eye with the IC-8 Apthera, we will sacrifice some sharpness and brightness to gain intermediate and some near vision.’ If they are OK with this, we proceed.” Robert Ang, MD Uncorrected Near Best Corrected Near Uncorrected Distance Best Corrected Distance Baseline 20/62 (0.49) 20/39 (0.29) 20/110 (0.74) 20/46 (0.36) POM1 20/36 (0.26) 20/25 (0.1) 20/44 (0.34) 20/30 (0.17) POM3 20/38 (0.28) 20/25 (0.1) 20/38 (0.28) 20/29 (0.16) Baseline-POM1 (lines improved) 2.6 1.4 6.6 1.6 Baseline-POM3 (lines improved) 2.4 1.4 7.2 1.7 Need for removal due to Dimming 3 patients In “Clinical outcomes of the small aperture IOL for complex corneas with irregular astigmatism,” presented at the 2024 ASCRS Annual Meeting, UCDVA improved by 7.2 lines and UCNVA improved by 2.4 lines at 3 months. Source: Nicole Fram, MD
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