EyeWorld India December 2014 Issue

December 2014 23 EWAP SECONDARY FEATURE continued on page 24 Future options for presbyopia by Ellen Stodola EyeWorld Contributing Writer Presbyopia-correcting options differ for patients around the world I OL options for presbyopia correction differ from country to country. There are a number of technologies being tested and used to treat patients, including trifocal IOLs, types of accommodating IOLs, and other unique technologies. Additionally, many other ideas are coming to light to treat these patients. Damien Gatinel, MD, PhD , Rothschild Foundation, Paris, France, and Richard Lindstrom, MD , Minnesota Eye Consultants, Minneapolis, Minn., U.S., discussed which technologies they are using and what they see potential for in the future of presbyopia correction. Trifocal IOLs Trifocal IOLs offer different advantages than the normally bifocal IOLs, and Dr. Gatinel has experience working with these types of lenses. “I have engineering and pioneering experience with the FineVision IOL, which I co- designed,” he said. “It has become my main indication for premium IOL surgery in patients who seek spectacle independence.” This PhysIOL technology (Liege, Belgium) provides both The FineVision IOL Source: Erik L. Mertens, MD, FEBOphth near and intermediate vision in addition to distance correction, and it alleviates the need for mix-and-match strategies. “In my experience, diffractive multifocal IOLs are more robust for any irregular corneal astigmatism than refractive multifocal ones,” Dr. Gatinel said. Accommodating IOLs Dr. Gatinel has not yet found success with accommodating IOLs. “My experience with accommodating IOLs has been negative,” he said. “I have not found any effective design and reproducible concept yet.” Dr. Lindstrom is enthusiastic about a few technologies and ideas that are being developed for accommodating IOLs. He mentioned the AkkoLens product (Breda, the Netherlands), which is currently being tested in a clinical trial in Europe. The lens uses a dual optic system with the 2 lenses moving across each other from side to side. “Instead of an in-the-bag lens, it’s in the ciliary sulcus, so it’s pushing against muscle when it accommodates; it’s a more reliable power source,” he said. “That lens is showing promise to be a real accommodating intraocular lens that can generate accommodating amplitudes superior to what we recognized in early technologies.” Other ideas not currently in patients may be good options for presbyopia correction, Dr. Lindstrom said. One concept proposes using interface fluids so that when the patient looks down, the power increases, and when the patient looks straight ahead, the power of the lens decreases. “It’s been very difficult to develop an accommodating intraocular lens,” Dr. Lindstrom said. One issue with this is fibrosis. “After you remove a cataract, the capsular bag undergoes fibrosis and loses its elasticity, and the amount of elasticity that it loses is different for every patient,” he said. This means that in some patients, even though a lens could work, the capsular bag is totally rigid. Even though the ciliary muscle is doing its work and changing shape and accommodating, the capsular bag does not change shape. The forces generated have created a challenge. “We have not learned how to eliminate that problem,” Dr. Lindstrom said. One way to possibly eliminate it is to bypass the capsular bag and go right to the ciliary muscle and use force generated directly rather than indirectly. “This seems promising,” Dr. Lindstrom said, although surgeons generally like to put lenses in the bag. FluidVision PowerVision (Belmont, Calif., U.S.) is currently working with an in-the-bag lens, the FluidVision lens, which Dr. Lindstrom said has potential. It is in trials in Germany. “It uses a hydraulic system,