EyeWorld Asia-Pacific June 2018 issue

14 EWAP FEATURE September 2017 into injectors manually. If you look at multifocals once they’re in the eye, there are often little scratches or ding marks on them because someone touched the optic surface. It would be nice if they were preloaded by an expert in the factory. The next step beyond that would be to have an auto-inject type of system. Alcon has one cur- rently, but it’s cumbersome to use. It would be nice if the injector itself auto-advanced. The AutonoMe looks promising,” he said. Dr. Rubenstein added that it would be helpful for injectors to go through smaller incisions. “The smallest inserter goes through a 1.8-mm incision. I think there is some value to developing inserters that go through even smaller inci- sions. Advantages would include less induced astigmatism and a smaller wound to worry about with postoperative wound leaks or post-traumatic wound leaks. I think there will be more movement toward preloaded lenses and auto- insertion techniques. We will need to evaluate these developments as they come along and determine if they are making a significant im- pact in clinical outcomes,” he said. Future Extended range of focus lenses and trifocals are the next lenses to gain popularity in the U.S. “My Europe- an colleagues tell me that they are predominately using two categories of IOLs: extended depth of focus and trifocals,” Dr. Koch said. “Their use of multifocals has dropped dramatically in lieu of these other options. The elegance of the trifo- cal IOL is that it actually loses light compared to the multifocal IOL. It provides a more continuous range of vision from distance to near with no increase and perhaps fewer glare symptoms than a multifo- cal IOL. I will also be interested to see how extended depth of focus IOLs might be modified to extend their near range while preserving the excellent quality of vision they provide. Also, manufacturers are designing pseudoaccommodative IOLs with new optical properties. Our industry colleagues are making great strides for our patients.” EWAP Editors’ note: Dr. Miller has financial interests with Alcon and Johnson & Johnson Vision. Dr. Koch and Dr. Rubenstein have no financial interests related to their comments. Contact information Koch: dkoch@bcm.edu Miller: kmiller@ucla.edu Rubenstein: jonathan_rubenstein@rush.edu Current state – from page 13 June 2018