19 EyeWorld Asia Pacific | June 2024 About the Physicians Sumit “Sam” Garg, MD | EyeWorld Chief Medical Editor, Vice Chair of Clinical Ophthalmology, Medical Director, Director of Technology, Professor – Cataract, Corneal & Refractive Surgery, Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California | gargs@hs.uci.edu R. Doyle Stulting, MD, PhD | Chief Medical Officer, Ocumetics Technology Corp. Founder, Stulting Research Center at Woolfson Eye Institute, Professor of Ophthalmology, Emeritus Emory University, Loudon, Tennessee | dstulting@icloud.com John Vukich, MD | Founding Partner Central American Ophthalmic Research Consultants, Summit Eye Care, Madison, Wisconsin | javukich@gmail.com George Waring IV, MD | Waring Vision Institute, Mt. Pleasant, South Carolina | georgewaringiv@gmail.com Relevant Disclosures Garg: LensGen Stulting: Ocumetics Vukich: JelliSee Ophthalmics Waring: Atia Vision This article originally appeared in the March 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. ASIA-PACIFIC PERSPECTIVES Robert Edward Ang, MD Asian Eye Institute 8th Floor, PHINMA Plaza, Rockwell Center, Makati City, Philippines angbobby@hotmail.com The quest for a full range of vision without compromise continues. For many years, we have been conditioned to believe that the accommodating IOL is the Holy Grail that will restore vision to a youthful state of ability, after cataract surgery. The different approaches we have gone through over the years, from monovision to multifocal optics and to extended depth of focus, were mere stepping stones to the promised land. Fortunately, like most surgeons, I have many happy patients who feel very satisfied, are enjoying their vision, and have accepted the compromises that came with IOLs. Current IOLs are small and flat. After implantation, the capsular bag collapses to hug the IOL so presbyopia correction relies solely on static lens optics. The accommodating IOLs in development are much larger, and most are comprised of two-piece components which remind me of the Harmoni modular IOL we worked on many years ago. The base component occupies and expands the capsular bag space to keep it open and may contain some fluid or air. Within the lens base is a second component that moves to shift the focus from far to near and vice versa. These dynamic changes in focus have to rely on the participation of the natural accommodative mechanism through ciliary muscles forces, thus justifying the “accommodating” name. Among the challenges I foresee in the development and future adaptation of accommodating IOLs are the degree of difficulty in implantation, capsular fibrosis and opacification and quantification of ciliary muscle forces to effect movement of the components of the lens complex. I believe the time has come when we need to create and define a new category of what is considered an accommodating IOL. This is to avoid confusion similar to how the ANSI standard was adopted as a definition for extended depth of focus (EDOF) IOLs. In my opinion, these standards should include implantation within the capsular bag, dynamic movement or shape change of components, specific minimum amount of diopteric change and proof of a single focal point instead of elongation or multiple focal points. We are excited to see many projects on accommodating IOLs moving forward. It seems like there is a race for who will get there first. We hope all the designs reach the finish line so surgeons have the opportunity to select which model they would like to use on their patients. Editors’ note: Dr. Robert Edward Ang disclosed no relevant financial interests. REFRACTIVE SURGERY
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