Eyeworld

I INNOVATIONS IN LENSES N FOCUS 108 | EYEWORLD | APRIL 2019 Dr. Trindade sees a benefit of XtraFocus being piggyback: Surgeons have the freedom to choose their preferred IOL with no power restric- tion, which he noted is important in post-RK and keratoconus cases. "In keratoconus, a low-powered IOL is often needed because of the high corneal curvature, while in post-RK cases a high-powered IOL is usually necessary because of the very flat cornea," he explained, noting what he thinks are limitations of the IC-8, namely its power range (+15.5 to 27.5 D) and lack of a toric version. Although the pinhole effect is able to "neu- tralize" some regular astigmatism, in some post- PK and keratoconus patients, a high-cylinder toric IOL plus XtraFocus may be a good combination, Dr. Trindade said. Confirmation of topographic stability is mandatory before surgery. The ideal refractive target when XtraFocus is implanted at the time of cataract surgery for treatment of irregular astigmatism is –2 D, while patients with normal corneas seeking extended depth of focus should be targeted for –0.75 D. Fitting in with other innovations With continued innovation in other areas of IOL technology, such as adjustable IOLs, where does the pinhole effect fit in? Dr. Vukich envisions that the two might be synergistic. An adjustable IOL can achieve a specific refractive endpoint, Dr. Vu- kich said, but it doesn't provide depth of focus. "The IC-8 is intended to be used in one eye, in a monocular state. It might be that the fellow eye could be treated with a Light Adjustable Lens [RxSight], and given that combination, you could pinpoint the vision where you want it to be and provide a consistent outcome," he said. Overall, Dr. Waltz said because the IC-8 is only implanted in one eye, it could be a less ex- pensive presbyopia-treatment compared to others on the market and thus could provide access to more patients. Pinhole optics is something that ophthal- mologists and optometrists use every day, Dr. Thompson said. "The beauty is its simplicity and how used to it we all are. The patient explanation is so easy. I've enjoyed the ease of patient education and the simplicity and power of this timeless optical prin- ciple now applied to the IC-8 implant," he said. XtraFocus While corneal irregularities are a secondary focus of the IC-8, XtraFocus, a piggyback implant for the ciliary sulcus, is specifically designed to ad- dress them. The main indication for this implant, according to Dr. Trindade, is for irregular astig- matism with secondary indications being en- hanced depth of focus and dysphotopsias related to previous multifocal IOL implantation. "It is a matter of going after the most rele- vant unmet need, which in my opinion, is irregu- lar corneal astigmatism," Dr. Trindade said. "As with any new technology, it is best suited for cases where currently available treatments have shown to be ineffective." The fourth-generation XtraFocus with a total diameter of 14 mm, an optic diameter of 6 mm, and pinhole diameter of 1.3 mm was CE marked in September 2016, and according to Dr. Trindade, Morcher is planning an FDA trial for 2020. The implant's larger overall diameter and thin (250 µm) haptics angled at 14 degrees with rounded, polished edges help prevent uveitis-glau- coma-hyphema syndrome, according to Morcher. Dr. Trindade said XtraFocus could be im- planted at the time of cataract surgery or after cataract surgery. "In some cases of irregular astigmatism, conventional cataract surgery may give surprising- ly good results. Therefore, a secondary pinhole implantation is usually advisable," he said. "How- ever, in cases of larger pupils (>4 mm mesopic), a primary approach is reasonable to spare a proba- ble second surgical intervention. Therefore, pupil diameter assessment is key to assist this decision." continued from page 107 XtraFocus is a piggyback pinhole implant indicated for treatment of irregular corneal astigmatism. Source: Claudio Trindade, MD Financial interests Thompson: AcuFocus Trindade: Morcher Vukich: AcuFocus Waltz: AcuFocus

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