EyeWorld Asia-Pacific June 2018 issue

June 2018 24 EWAP FEATURE A range of futuristic IOLs coming down the pipeline by Liz Hillman EyeWorld Staff Writer AT A GLANCE • There are a range of “futuristic” IOLs available outside the U.S. or still in development. • Improving presbyopia correction is a major target for many IOLs, including trifocals (currently unavailable in the U.S.) and accommodating IOLs, many of which are still in clinical trials. • Postoperative adjustability is an element on ophthalmologists’ wish list to allow them to easily correct missed targets. • Other technologies seek to prevent IOL-induced aberrations, such as negative dysphotopsia. Next generation IOLs seek to provide accommoda- tion, adjustability, and more U ntil a method to pre- vent cataracts alto- gether is developed, cataract surgeons will seek out IOLs that can provide vision that most closely resembles that of a youthful, natural lens. “We ultimately want an adjustable and accommodating intraocular lens,” said Richard Lindstrom, MD , Minnesota Eye Consultants, Minneapolis, and member at large, ASCRS Executive Committee. “I want a lens that’s going to give me the accommodation of a 30-year-old, and I want to be able to hit perfect plano so I can have razor-sharp, 20/20 distance vision too,” Uday Devgan, MD , Devgan Eye Surgery, Los Angeles, said of his IOL wish list. Companies are working toward this goal on many fronts, as well as addressing some of the unwanted visual aberrations that occur with current lens designs. While some of these IOLs are already on the market in the U.S., others are only available outside the U.S. or are still in other stages of develop- ment. IOLs zoom in on presbyopia correction In the realm of presbyopia-cor- recting IOLs, though some are available in the U.S., many cur- rently remain out of reach for U.S. physicians. There are no trifocal designs, for example, in the U.S. market, though they are widely available elsewhere. Dr. Lindstrom said despite the availability of some presbyopia-correcting IOLs in the U.S. (there are several multifocal designs, one extended depth of fo- cus [EDOF], and one accommoda- tive), he would certainly welcome more options. “A bifocal multifocal gives you far and near, and the weakness is intermediate [vision]. The EDOF gives you far and intermediate, and the weakness is near. The trifocal gives you all three,” Dr. Lindstrom said, noting a potential loss of con- trast sensitivity and night vision symptoms with trifocals. “I think [a trifocal] is a lens we are going to want to have available, and we will.” Small diameter aperture IOLs, such as the IC-8 (AcuFocus, Irvine, California) and XtraFocus (Morch- er, Stuttgart, Germany), allow the patient near vision through the implanted eye, while the dominant eye functions for distance vision. These types of IOLs, Dr. Lindstrom said, are particularly useful for eyes with significant higher order aber- rations because they essentially create a miotic pupil. “It’s a lens that has a specific indication,” Dr. Lindstrom said, mentioning RK, early PRK and LASIK, keratoconus, and corneal injuries as examples. Dr. Devgan said multifocal designs, including EDOF and trifo- cals, are a “stop-gap measure.” “They’re just to fill the years ahead of us until we have a truly accommodating IOL. Instead of trying to develop more multifocal lenses, we are trying to develop truly accommodating lenses,” he said. Two such lenses are available in the U.S.: the Crystalens (Bausch + Lomb, Bridgewater, New Jer- sey) and Trulign Toric (Bausch + Lomb). Both have flexible haptics that, with movement of the ciliary muscle, push the optic upward, allowing for an accommodative- like effect. A review published in Current Opinions in Ophthalmol- ogy evaluated recent findings on both of these IOLs, finding them The Juvene accommodating IOL is a dual, fluid-optic system that uses the ciliary muscle to achieve accommodation. Source: Michael Landreville/LensGen