18 EyeWorld Asia Pacific | June 2024 What is seen with this lens is binocular summation, he said, so if you have it in both eyes, those patients as a whole did better than patients who just had it in one eye. “I think that’s true of most of these lenses. This is not a monovision effect. This is a distance-corrected actual effect of the lens,” Dr. Garg said. The incision for the Juvene lens is around 3–3.2 mm, Dr. Garg said, adding that “the only real learning curve with the surgery is getting used to the two-part insertion and tabbing it in the eye.” In terms of safety, he said endothelial cell counts are similar to traditional surgery, and there hasn’t been any major inflammation. You don’t get significant PCO because the bag stays open, he said. “This is not just true of the Juvene; it’s true for any of these lenses that keep the bag open.” So far, the results have been promising with the published data, he said. JelliSee IOL by JelliSee Ophthalmics John Vukich, MD, has been working with the trial of the JelliSee IOL, which he said is a lens that is designed to mimic the natural lens of a child. In its resting state the lens will, by design, be focused for near. One of the key features of the design is that it does not rely on whole bag compliance, capsular contraction; it does not rely on the posterior capsule; it is activated by a change in the diameter of the capsular bag complex. “The lens is fundamentally different, as its mechanism of action is actually potentiated by fibrosis of the lens capsule.” JelliSee, he said, has undergone an initial clinical trial, and there is data from both primates and humans. These studies were conducted in El Salvador, where Dr. Vukich participated as the primary surgeon, having done all the cases to date. Dr. Vukich has been involved with the development, surgical technique, postoperative care, and data associated with the JelliSee IOL, and said that there is currently 1-year data on 10 patients. “We are able to demonstrate reliably up to 7 D of accommodative change,” he said. This lens, he added, can be used for anyone who has a need for cataract surgery, and, at some point, refractive lens exchange may become an indication as well. “One of the fundamental design features of the lens is that the change in the shape occurs on the anterior surface of the implant, and the activating force is applied by the capsular ring complex anterior to the equator of the lens,” he said. “The lens achieves an enhanced level of translation of the applied force by moving the point of contact with the lens anterior to the equator. It results in a more dynamic anterior surface change. The lens design optimizes the translation of mechanical force from the ciliary body creating a much more efficient ability to change the shape of the anterior surface of the lens.” Multiple studies have shown that the ciliary muscle remains strong and functions throughout life and is able to exert, on average, 0.08 Newtons of radial force. The lens is designed to use this available force by creating eight points of contact within the peripheral capsular bag. The posterior capsule and capsulotomies do not contribute to the mechanism of action. “As the capsular bag fibroses with time, it potentiates the translation of the ciliary body movement into the capsular ring diameter, and the lens becomes more efficient. Rather than a concern about capsular bag fibrosis leading to a disadvantage of the mechanism of action, it’s actually the exact opposite,” he said. “It improves the mechanism of action, and we are seeing that both with the longer-term primate studies as well as in our human studies.” The lens is designed so that 114 microns of total diameter change is enough to activate the entire potential of the lens, he added. That is what is needed for the full dynamic 7 diopter range of the lens, he said. “Even patients who can generate only half the average amount of force will still be able to achieve 4.5–5 D of accommodative changes. It’s a very robust system that doesn’t require an average response; even a suboptimal response will still provide a significant diopter change.” Dr. Vukich said that all patients who have been treated with this lens have been done with only three different base powers. The large dynamic range means that we can target the patient for hyperopia and the patient will then naturally focus for distance. The best-corrected visual acuity in all patients was 20/20 or better, he said, and near is a natural function that occurs in the first day or two postoperatively and becomes more robust at 1 month. OmniVu modular shape-changing lens system by Atia Vision The OmniVu modular shape changing lens system consists of a fixed-power front optic and fluid-filled, shapechanging base lens, making it somewhat unique in the marketplace and developmental pipeline, according to George Waring IV, MD. “The goal is to treat cataract and address the effects of presbyopia by harnessing the natural lens accommodating mechanism of the eye, and the way this works is that there is a fixed-power front optic hydrophobic acrylic, and it has docking tabs that are around the periphery of the optic,” he said. “Then, there’s a shape-changing, fluidREFRACTIVE SURGERY
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