Eyeworld

28 | EYEWORLD | JUNE/JULY 2020 ATARACT C by Liz Hillman Editorial Co-Director W hen ophthalmologists talk about using small aperture optics to enhance a patient's depth of focus for increased spectacle independence, most would con- sider using such technology in the patient's non-dominant eye. But research involving an IOL that draws on pinhole principles is showing that bilateral im- plantation might give patients even better visual satisfaction than simply going monolateral. "The notion of monolateral implantation came from the KAMRA inlay [AcuFocus]," said Robert Ang, MD. "There is an impression that bilateral small aperture will be too dim, visual field constricted, and contrast sensitivity decreased." But that's not what Dr. Ang found in his prospective, non-randomized, non-compara- tive study that used the IC-8 IOL (AcuFocus), which is not yet approved in the U.S. 1 In the study, Dr. Ang implanted a monofocal IOL in one eye of 10 patients and IC-8 in the other. A second group had the IC-8 implanted in both of their eyes, self-selecting to receive IC-8 in the second eye after a positive experience with the first. Visual acuity, patient satisfaction, task per- formance, visual symptoms, defocus curves, and contrast sensitivity were tracked for at least 12 months and compared between the two groups. Overall, Dr. Ang found that "the combina- tion of small-aperture IOL and micromonovi- sion allows an improvement of visual perfor- mance, especially in the near and intermediate near range," he wrote in the study. All patients achieved 20/32 or better for uncorrected and corrected distance visual acuity at all distances, regardless of contralateral or bilateral implan- tation. But uncorrected intermediate and near visual acuity was 0.5–1 line greater in patients who received IC-8 in both eyes. IC-8 implanted bilaterally extended depth of focus range by 0.25 D. Bilateral patients also reported better satisfaction and ease with near tasks and with spectacle independence. Contrast sensitivity was similar in both groups, but bilateral patients reported slightly more glare and halo, while the monolateral group had slightly more blurry or fluctuating vision and double vision (none of these symptoms were statistically significant). Even with these results, Dr. Ang told EyeWorld that not all patients will be able to tolerate bilateral implantation of a small-aper- ture IOL. He stressed careful patient selection. "Patient preference has been a good predictor for us in recommending bilateral implantation. Study compares small-aperture IOL implantation in one or both eyes About the doctor Robert Ang, MD Asian Eye Institute Makati City, Philippines Undilated eye with IC-8

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