Eyeworld

I TECHNOLOGY & INNOVATION N FOCUS 42 | EYEWORLD | MAY 2019 years away from implementing this technology in our everyday clinical practice," she said. Dr. Garg described the Juvene fluid-filled lens (LensGen), one example of a modifiable component IOL. According to Dr. Garg, the IOL has a modular design that employs a dual optic principle—one fixed, the other fluid-filled—and has delivered up to 3 D of accommodation in early trials. Improving technology improves outcomes All these technologies combined "cumulatively improve cataract surgery outcomes for our pa- tients," Dr. Weinstock said. "[I]f you take all of these advances in our field and use them togeth- er in a process it translates into a more refined, safer, and predictable surgery and outcome for the patients." These advances allow surgeons to be more accurate in their outcomes, and "when com- bined with diligent preparation of the ocular surface, refractive surprises are less apt to occur," Dr. Garg said. Providing context for these advances, Dr. Lee noted that "history has proven the brilliance of Charles Kelman's innovation of phacoemulsification. It is still the best way to break up and remove a cataract more than 50 years after its introduction," he said. Fortunately, surgeons "have gotten better and better at picking the correct IOL and mak- ing cataract surgery a true refractive procedure." "The next step will be improved ability to refine outcomes after phaco and improving range of vision with fewer optical trade-offs," he added. "[O]ur technology has allowed us to keep up with progressively increasing patient de- mands and expectations, in most cases," Dr. Donaldson said. "Industry has worked very closely with surgeons to continually improve IOL technology, phaco technology, and diag- nostics that help us best prepare for cataract surgery. Spectacle independence has become a major factor in how patients measure surgical success. The technology that we have available to us helps us achieve this goal for our patients, making our job as surgeon easier and more satisfying." a much more efficient and heads-up oriented procedure, which everyone in the room can par- ticipate in and add value to," he said. Dr. Donaldson also uses both the ORA and the CALLISTO to help orient toric lenses. "The ORA is also particularly helpful for post-re- fractive cases," she said. "I have become much more aggressive with astigmatism correction over the past decade, especially with regard to the correction of against-the-rule astigmatism," subsequently improving refractive outcomes overall. Postoperative adjustments One way to hit refractive targets and achieve optimal outcomes is to broaden the range of focus, reducing the need for pinpoint accuracy. Dr. Lee mentioned the AcuFocus IC-8 (AcuFo- cus), a pinhole monofocal implant undergoing a clinical trial that he said "should provide some range of vision without the type of night symp- toms that current MFIOLs and the Symfony [Tecnis extended depth of focus IOL, Johnson & Johnson Vision] cause." All the doctors look forward to technolo- gies that will allow them to modify sphere and cylinder postoperatively, hitting their targets after the fact. "This will be a huge advantage to cataract and refractive surgeons alike, as they are now able to easily make adjustments and enhancements to patients postoperatively without an additional surgical procedure or intraocular lens exchange," Dr. Weinstock said. "The promise of 20/15 vision for all patients is certainly on the horizon with technologies like this in development." Among these technologies, the Light Ad- justable Lens (RxSight), already approved by the FDA, is "the initial player in this new arena," Dr. Donaldson said. Other technologies are forthcoming. She said there are several forms of compo- nent IOLs in development. These IOLs have exchangeable optic segments to allow modifi- cation from monofocal to multifocal and vice versa as well as adjustment to refractive error postop. "Eventually, refractive indexing will allow us to modify the refractive error with a laser postoperatively; however, we may still be several continued from page 41 Financial interests Donaldson: Alcon, Allergan, Bausch + Lomb, Bio-Tissue, Johnson & Johnson Vision, Sun Pharmaceutical, Shire, Kala Phar- maceuticals, Eyevance, Lumenis, Carl Zeiss Meditec Garg: Johnson & Johnson Vision, LensGen, Carl Zeiss Meditec Lee: AcuFocus, Carl Zeiss Meditec Weinstock: Alcon, LENSAR, Carl Zeiss Meditec

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