Eyeworld

I INNOVATIONS IN LENSES APRIL 2019 | EYEWORLD | 107 tion a non-issue. He also said that while they are trying to hit –0.75 D in the IC-8 eye and plano in the monofocal eye, international colleagues find this combination tolerates small deviations from the intended target, reducing the need for postop enhancements. Dr. Waltz said those who need to do more close work or who are shorter in stature may be better suited for other presbyopia-correcting options. Retinal issues, however, are not contrain- dications, Dr. Waltz said, explaining that the retina and optic disc can be viewed and imaged well through the pinhole. Post-RK, post-refractive surgery, keratocon- ic, and scarred corneas all give cataract surgeons pause because they complicate accuracy in hitting refractive targets. Dr. Vukich called the IC-8 a "rescue option" for these patients. Though nei- ther the lens' primary use nor one being studied in the FDA trial, this technology has found "great utility" in difficult cases, Dr. Vukich said. As Dr. Thompson said, "the landing strip is wider because you are extending depth of focus and there is a much higher chance of patient sat- isfaction by doing so. We're seeing internationally high patient satisfaction at those small levels of residual refractive error because we are extending depth of focus." good visual acuity and natural range of vision with less variation as you move an object closer or farther. "The pinhole works beautifully through distance, intermediate, and some level of close, and starts to fall off in a typical way that normal vision falls off," he said. John Vukich, MD, an investigator in the U.S. trial, said that so far, this lens has provided high quality vision with smooth transitions. "There is a smooth depth of focus without any transitions like we would see with a traditional multifocal or trifocal lens," he explained. "It is a lens that has shown it does not diminish distance visual acuity and has minimal symptoms of glare, halo, and some of the more troubling optical ab- errations that are inherently part of what we see with traditional multifocal lenses." Vance Thompson, MD, who is also an inves- tigator on the current trial, said patients seeking spectacle independence is the fastest growing area of his practice. Experience from international colleagues, Dr. Thompson continued, shows an impressive range of vision and quality of vision with this IOL. The original lens was essentially taking a KAMRA inlay (CorneaGen, originally produced by AcuFocus) and putting it into a three-piece silicone IOL, Dr. Waltz said. The current iteration IC-8 incorporates more sophisticated sizing of the aperture (1.36 mm) and overall diameter (3.23 mm), and a single-piece acrylic design, which Dr. Thompson said is a very comfortable platform for cataract surgeons. The physicians noted this lens is very for- giving and centers well. Though the IC-8 centers well, in general, Dr. Waltz said that decentration at the IOL plane seems much less of an issue than it is at the corneal plane (centration of the KAMRA inlay is very important). This lens also tolerates up to 1.5 D of astigmatism, Dr. Vukich said, putting less burden on the physician. "This lens is forgiving and produces equal quality of measurements up to a diopter and a half of astigmatism," Dr. Vukich said. Dr. Thompson said the IC-8 is a benefit for patients with astigmatism at or below this level, compared to a toric IOL, because it makes rota- continued on page 108 u What is the pinhole effect? About the doctors Vance Thompson, MD Vance Thompson Vision Sioux Falls, South Dakota Claudio Trindade, MD Cançado Trindade Eye Institute Belo Horizonte, Brazil John Vukich, MD Director Davis Duehr Dean Center for Refractive Surgery Madison, Wisconsin Kevin Waltz, OD, MD President Ophthalmic Research Consultants Indianapolis A pinhole, or small aperture, blocks peripheral rays of light, letting only focused light through the center of the optic to enter the eye. This improves the quality of the light that is getting through, and, thus, image quality is improved.

• Blank Page
• Blank Page (1)