Eyeworld

46 | EYEWORLD | DECEMBER 2022 ATARACT C Relevant disclosures Donnenfeld: AcuFocus, Alcon, Johnson & Johnson Vision, Rayner Kugler: None Lee: None Contact Donnenfeld: ericdonnenfeld@gmail.com Kugler: lkugler@kuglervision.com Lee: bryan@bryanlee.pro according to Dr. Donnenfeld, include patients with amblyopia, macular degeneration, or other pathology in one eye to the extent where the vision has deteriorated, and the patient thus would not be happy with vision in that eye for near or far. Dr. Donnenfeld said he'll also steer away from monovision in patients who are athletes and need depth of focus. Golfers, for example, can't see the greens well with monovi- sion, he said. Dr. Donnenfeld doesn't specifically trial monovision with contact lenses in patients who The IC-8 Apthera IOL was approved by the FDA in July 2022. When EyeWorld spoke with Dr. Donnenfeld, Dr. Kugler, and Dr. Lee, it was not yet available commercially in the U.S., but they shared their insights on how this IOL would benefit patients with EDOF capabili- ties as well as some therapeutic uses. Dr. Donnenfeld noted that the IC-8 Apthera was approved as an EDOF IOL. "It was approved on virgin eyes that had good visual potential, and the patients did very well in the FDA trials. The nice part about the lens is it doesn't split light. It's a true EDOF lens. It gives dramatically more near than the Vivity, Eyhance, and RayOne EMV, so it gives patients that extra near that they want, and it doesn't compromise dis- tance. In fact, it very commonly improves dis- tance. I think there is a significant opportuni- ty to add this lens to your portfolio. I think it's a good consideration for people who want monovision. You will get more reading from this lens than you will from the other EDOF lenses that we generally think about." The biggest opportunity, however, that he and other physicians consider for the IC-8 Apthera is in irregular corneas. "I think this will be one of the more important new technologies that we add to our arma- mentarium for the most challenging patients in our practice. This lens is going to solve problems that previously were unsolvable for many patients," Dr. Donnenfeld said. Dr. Lee, who participated in the clinical trials for the IC-8 Apthera, said that the lens will be helpful for monovision, even when set for –0.75 to –1 D, but he is also looking forward to its use for irregular corneas. "Additionally, the IC-8 Apthera will allow for continued RGP wear for patients, unlike a toric IOL or Light Adjustable Lens. Irregular corneas will be an off-label use because those patients were excluded from the trial, so I expect that surgeons will start using it and see how their patients do, just as with any new technology. However, it will be im- portant for us to have reasonable expecta- tions for the IOL because it would be unfair to expect miraculous results in abnormal, highly aberrated eyes," Dr. Lee said. Dr. Kugler, also an investigator in the IC-8 Apthera trial, said this lens might be attrac- tive for surgeons who have been hesitant to offer multifocals due to the management or enhancement needed for them. "For cataract surgeons who don't have ac- cess or capability to enhance those patients, multifocals are very difficult to use success- fully. You tend to get frustrated with them and stop offering them. I think that's a huge complexity to multifocal IOLs, whereas the IC-8 Apthera is very forgiving. The enhance- ment rate is not zero but it's lower than what you would have with a multifocal," Dr. Kugler said. He noted that while he doesn't have experi- ence with post-refractive eyes and the IC-8 Apthera, if you look at the work of interna- tional ophthalmologists, the IC-8 Apthera is a common solution for post-refractive eyes. "I do wonder how it's going to fit into what we're doing for post-refractive IOLs. The Light Adjustable Lens is great, but it also has its downsides," Dr. Kugler said, adding that looking at international experience, he thinks it will be an especially good option for post- RK eyes. IC-8 Apthera makes U.S. debut continued from page 45

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