EyeWorld India December 2017 Issue

65 EWAP DEVICES December 2017 by Michelle Stephenson EyeWorld Contributing Writer Accommodating IOLs in the pipeline A glance at promising lenses in the works C rystalens (Bausch + Lomb, Bridgewater, New Jersey) remains the first and only FDA-approved accommodating IOL. Currently, companies are working to design an IOL that provides reliable ac- commodation, and several prom- ising lenses are in the pipeline. LensGen LensGen (Irvine, California) is developing Juvene, which is the first modular, fluid-optic accom- modating IOL. It provides accom- modation by mimicking the eye’s natural accommodation process to change shape and adjust focus. “I was the first person to implant that lens in Panama in 2015,” said Uday Devgan, MD , Los Angeles. “We’ve since done dozens of patients, and we’re starting up a large trial soon.” With the Crystalens first- generation debut, the optic moved forward and backward. “That didn’t work because that’s not how a human lens works. The lens in a younger person’s eye can accommodate a lot, but it doesn’t move front to back. The lens changes curvature. The best way of solving these problems is to mimic Mother Nature. The LensGen design mimics human nature, and the curvature of the IOL will increase, therefore in- creasing its power,” he said. Eric Donnenfeld, MD, Rock- ville Centre, New York, agreed that the LensGen Juvene AIOL looks promising. “This fluid-lens works by changing shape in the eye in a similar way to how the natural lens works. What makes it special is that it is a two-lens system. One of the lenses, the base lens, serves as a regular IOL, so it has all of the aspects of a standard, monofocal IOL. You then place the fluid-lens accom- modating portion into the base lens portion, and that allows you to put the lens in through a smaller incision and allows the lens to become more functional. The two-lens system also retains the volume of the capsule, which maximizes refractive stability, and an open capsule has been shown to reduce the incidence of PCO. Hopefully, this will be developed over the next couple of years and will become more readily avail- able. This is the IOL that I think is the most exciting for the short- term treatment of presbyopia,” he said. Elenza Elenza (Roanoke, Virginia) is de- veloping the Sapphire AutoFocal IOL. This next-generation accom- modating IOL uses a combina- tion of liquid crystal chemistry, electricity, and integrated cir- cuitry to create smart optics. The technology includes an electro- active switchable element that automatically adjusts focusing power electronically to maintain constant focus for different work and light environments. The lens is controlled by a micro-sized power cell, which has an expected 50+ year rechargeable cycle life. “There is a small battery built into the IOL that allows the lens to change its refractive index from near to far,” Dr. Donnenfeld said. “This is a good feature be- cause it doesn’t rely on any aspect of the body’s function. That has been the problem with IOLs. Cili- ary bodies can’t be counted on to move, or there may be concerns about the capsule contracting. This lens removes those concerns. For me, this is a science project, but a project that has great po- tential going forward. I think this will become the lens of the future, but it is probably 10 years away. I think this is the one true mecha- nism that will work very well.” PowerVision The FluidVision accommodating IOL by PowerVision (Belmont, California) contains a small amount of fluid that moves in response to the natural muscle forces in the eye. Future of presbyopia treat- ment According to Dr. Devgan, the best presbyopia treatment will be restoring accommodation with an IOL. “The cornea is not the source of presbyopia. Instead, it’s the hu- man lens. Everyone over the age of 50 will experience presbyopia. You can plot with a linear curve the amount of accommodation versus age. It’s so accurate that when people came here through Ellis Island from other countries and didn’t know their birthday or how old they were, they checked their accommodation and from that estimated the person’s age,” he said. EWAP Editors’ note: Dr. Devgan has fi- nancial interests with LensGen. Dr. Donnenfeld has financial interests with LensGen and Elenza. Contact information Devgan: devgan@gmail.com Donnenfeld: ericdonnenfeld@gmail.com The LensGen accommodating IOL Source: Eric Donnenfeld, MD