EyeWorld India March 2015 Issue

35 EWAP CATARACT/IOL March 2015 by Michelle Dalton EyeWorld Contributing Writer New technology IOLs: What’s here and what’s coming EyeWorld spoke to experts around the world about the latest new technology lenses N umerous new IOLs are under development and in clinical trials, all with the hope of treating presbyopia through multifocality or true accommodation. With estimates of market share for lenses currently on the market at about 5% to 6%, there is no arguing that clinicians would benefit from having newer lenses available, in both cataract and refractive markets. One major barrier to a greater market rate is that artificial accommodation has failed in the lenses currently available, experts say. In Europe, several of the newer technology lenses are designed for sulcus implantation— not intracapsular—which may be the eventual key to a truly accommodating IOL. Yet even the experts agree confusion remains over the terminology. “What constitutes a new technology lens? Extended depth of focus (EDOF) or true accommodation?” said Nick Mamalis, MD , professor of ophthalmology, co-director of the Intermountain Ocular Research Center, and director of ocular pathology, John Moran Eye Center, Salt Lake City. He thinks the EDOF lenses are more of a refinement than a new technology. On the other hand, EDOF IOLs “are becoming an opportunity based on different optical factors,” which should qualify them for a “new technology” designation, said Jorge L. Alió, MD, PhD , professor and chairman of ophthalmology, Miguel Hernandez University, Alicante, Spain, and medical director of Vissum Corporation, Spain. “This EDOF is incorporated into some technologies … The Mplus [Oculentis, Berlin] has an increased depth of focus based on paraxial asphericity that works very well as an added value to the IOL near vision power.” continued on page 36 The Mplus is currently available in Spain and is “becoming extensively used in the private sector.” The lab of Dr. Mamalis and Liliana Werner, MD, PhD , uses research eyes and works with all the newer technology lenses, but “it’s frustrating because none of these technologies are available for our patients here in the United States,” Dr. Mamalis said. Ideally, he’d like to help streamline the U.S. regulatory approval process “to get the new technology available” in a shorter period of time. One of the biggest challenges today is that most lenses will improve best corrected visual acuity (BCVA), “but we still haven’t nailed the refraction. We still have issues with IOL predictions and accuracy, and there are some patients who will develop posterior capsule opacification (PCO) after surgery,” said Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin), consultant ophthalmologist at the Wellington Eye Clinic and Beacon Hospital, Dublin. EDOF lenses Several EDOF lenses are based on spherical aberrations, Dr. Cummings said. The MiniWell (Sifi Medtech, Aci Sant’Antonio, Italy) is the first preloaded, progressive, multifocal, aspheric IOL for mini incision able to offer high visual performance compared to the conventional diffractive IOLs. Currently the lens is undergoing a 2-armed study, and “initial results seem quite promising,” he said. Hoya (Chino Hills, Calif.) is also developing an EDOF lens based on spherical aberration, Dr. Cummings said. AcuFocus (Irvine, Calif.) has begun studies on “a small aperture hydrophobic acrylic IOL, a single- piece lens with a centrally located opaque annular mask with the same principle as the company’s KAMRA corneal inlay,” said Dr. Werner, associate professor and co-director of the Intermountain Ocular Research Center, John A.