Eyeworld

I INNOVATIONS IN LENSES N FOCUS 98 | EYEWORLD | APRIL 2019 by Vanessa Caceres EyeWorld Contributing Writer E ye surgeons in the U.S. are still anxiously awaiting the possibilities of adjustable IOLs as the technology itself continues to become more sophisticated in lab and clinical studies. At one point, there was one IOL in this category—the Light Adjustable Lens (LAL, RxSight). Now, the offerings have expand- ed to include the Perfect Lens (Perfect Lens LLC) procedure and technology from Clerio Vision that allows for an adjustment of the cornea, contact lens, or IOL. "All of our latest advances in preoperative biometry, intraoperative aberrometry, and IOL formulae have helped us to reduce the mean error and standard deviation of our IOL calculations," said David F. Chang, MD. "However, these meth- ods are still generating a prediction of the best IOL power to select and still rely on assumptions of the effective IOL position, surgically induced astig- matism, and posterior corneal astigmatism. We assume posterior corneal curvature based on the anterior corneal curvature, and this can introduce additional errors with keratoconus and post- LASIK eyes." This becomes even more complex with toric IOL calculations, Dr. Chang added. "With an adjustable IOL, we would wait until the IOL can no longer rotate or shift axially before treating the net postoperative refraction. We would no longer have to rely on preoperative assumptions," he said. The precision and accuracy of an adjustable lens will be especially valuable for difficult eyes, such as those post-LASIK, post-RK, extremely long or short eyes, oblique astigmatism, or eyes with mature cataracts that precluded preop optical biometry, he explained. Here's a summary of recent advances in ad- justable lens technology and when surgeons in the U.S. may find it clinically available. Light Adjustable Lens The LAL, which the U.S. FDA approved in late 2017, uses a proprietary ultraviolet light treatment that produces modifications in the lens curvature. The technology allows surgeons to reshape the lens based on a patient's individual vision cor- rection needs after cataract surgery. The lens is approved in the U.S. to correct hyperopia, myopia, An eye on future vision Adjustable lens technology continues to improve A rabbit eye implanted with a monofocal commercially available hydrophobic acrylic lens, which underwent refractive power adjustment by femtosecond laser Source: Liliana Werner, MD, PhD The Zepto capsulotomy achieved perfect 360-degree overlap of the Light Adjustable Lens so with capsule fibrosis, the lens is stable and does not tilt or decenter. Source: John Berdahl, MD At a glance • A growing number of companies offer IOLs that can be adjusted after cataract surgery. • The LAL has been around the longest and is approved by the U.S. FDA. However, it is not yet available commercially in the U.S. • Perfect Lens offers technology that allows for adjustment of a lens with a low-energy femtosecond laser. • The LIRIC approach also uses a femtosecond laser to adjust an IOL, cornea, or contact lens.

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