Eyeworld

I References Text goes here by Name Title INNOVATIONS IN LENSES APRIL 2019 | EYEWORLD | 113 Sulcus lenses No lens has been brought through an FDA trial for sulcus placement, so no available lenses are specifically designed for placement in that location, Dr. Masket said. A three-piece silicone, 6.3 mm IOL with polyimide haptics that is no longer available was the best off-label option for U.S. surgeons. Europe has one approved lens specifically designed for sulcus placement (Sulcoflex, Rayner), which is a single-piece hydrophilic available in low powers or as a piggyback lens to add multifocality. Among materials, Dr. Masket said silicone and hydrophilic acrylic are well tolerated but hydrophobic acrylic tends to be "tacky," and some patients have developed marked iris chaffing from it. Single-piece IOL vs. three-piece IOL Dr. Holladay said there is a need for a single-piece IOL over a three-piece IOL for lower powers (+5 to –10) in high myopia eyes. "But the frequency is so low, it is not cost effective for most companies," Dr. Holladay said. Dr. Masket warned about iris chafing concerns from meniscus design IOLs, which have a thin center and a thick edge. The thick, square, tacky, acrylic material can damage the posterior iris. In terms of addressing presbyopia in patients who have had previous cataract surgery, Europe has an approved lens (Sulcoflex) specifically designed for that situation, and surgeons have obtained good results with it. U.S. regulatory approval may be complicated by the lack of an existing lens designed for sulcus placement. "All of that said, there is a new FDA pathway for devic- es that fit unmet needs; clearly this is such a device, and they might be able to bring it to market with a less onerous path- way," Dr. Masket said. Additionally, as a presbyopic device, the lens has the advantage of being clearly reversible should the patient be intolerable of the diffractive add-on optic. "There is potentially a huge market for this device and I would hope that it becomes available to patients in the U.S.," Dr. Masket said. A F R E S H P E R S P E C T I V E ™ 2500 Sandersville Rd ■ Lexington KY 40511 USA lacrivera.com ( 855 ) 857-0518 © 2019 Lacrivera, a division of Stephens Instruments. All rights reserved. Advanced relief for dry eyes The VeraPlug™ FlexFit™ is an advanced solution to the discomfort of dry eye. It is simple to size and insert, comfortable for your patients, and comes with the confidence of our industry leading 45 day retention pledge. VeraPlug ™ FlexFit ™ 4 5 - D AY R E T E N T I O N P L E D G E * If a VeraPlug™ FlexFit™ is lost within 45 days of insertion, Lacrivera will replace it free of charge. IN STOCK AND READY TO SHIP! T E M P O R A R Y O C C L U S I O N Vera90™ Synthetic Inserts Extended-duration punctal inserts for diagnostic use and post-operative dry eye. VeraC7™ Collagen Inserts Temporary punctal inserts for diagnostic use, providing occlusion for up to 10 days.

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