Eyeworld

SPRING 2024 | EYEWORLD | 69 R be focused for near. One of the key features of the design is that it does not rely on whole bag compliance, capsular contraction; it does not rely on the posterior capsule; it is activated by a change in the diameter of the capsular bag com- plex. "The lens is fundamentally different, as it's mechanism of action is actually potentiated by fibrosis of the lens capsule." JelliSee, he said, has undergone an initial clinical trial, and there is data from both pri- mates and humans. These studies were conduct- ed in El Salvador, where Dr. Vukich participated as the primary surgeon, having done all the cases to date. Dr. Vukich has been involved with the de- velopment, surgical technique, postop care, and data associated with the JelliSee IOL, and said that there is currently 1-year data on 10 pa- tients. "We are able to demonstrate reliably up to 7 D of accommodative change," he said. This lens, he added, can be used for anyone who has a need for cataract surgery, and, at some point, refractive lens exchange may become an indication as well. "One of the fundamental design features of the lens is that the change in the shape occurs on the anterior surface of the implant, and the activating force is applied by the capsular ring complex anterior to the equator of the lens," he said. "The lens achieves an enhanced level of translation of the applied force by moving the point of contact with the lens anterior to the equator. It results in a more dynamic anterior surface change. The lens design optimizes the translation of mechan- ical force from the ciliary body creating a much more efficient ability to change the shape of the anterior surface of the lens." Multiple studies have shown that the ciliary muscle remains strong and functions through- out life and is able to exert, on average, 0.08 Newtons of radial force. The lens is designed to use this available force by creating eight points of contact within the peripheral capsular bag. The posterior capsule and capsulotomies do not contribute to the mechanism of action. "As the capsular bag fibroses with time, it potentiates the translation of the ciliary body movement into the capsular ring diameter, and the lens becomes more efficient. Rather than a con- cern about capsular bag fibrosis leading to a disadvantage of the mechanism of action, it's actually the exact opposite," he said. "It im- proves the mechanism of action, and we are seeing that both with the longer-term primate studies as well as in our human studies." The lens is designed so that 114 microns of total diameter change is enough to activate the entire potential of the lens, he added. That is what is needed for the full dynamic 7 diopter range of the lens, he said. "Even patients who can generate only half the average amount of force will still be able to achieve 4.5–5 D of ac- commodative changes. It's a very robust system that doesn't require an average response; even a suboptimal response will still provide a signifi- cant diopter change." Dr. Vukich said that all patients who have been treated with this lens have been done with only three different base powers. The large dynamic range means that we can target the patient for hyperopia and the patient will then naturally focus for distance. The best-corrected visual acuity in all patients was 20/20 or better, he said, and near is a natural function that oc- curs in the first day or two postoperatively and becomes more robust at 1 month. OmniVu modular shape- changing lens system by Atia Vision The OmniVu modular shape changing lens system is comprised of a fixed-power front optic and fluid-filled, shape-changing base lens, mak- ing it somewhat unique in the marketplace and developmental pipeline, according to George Waring IV, MD. "The goal is to treat cataract and address the effects of presbyopia by harnessing the natural lens accommodating mechanism of the eye, and the way this works is that there is a fixed-power front optic hydrophobic acrylic, and it has docking tabs that are around the periphery of the optic," he said. "Then, there's a shape-changing, fluid-filled base." The front fixed-power optic docks into that, and it's a modular system that allows for customization in the future, he said. This lens is designed to restore a full range of vision and minimize continued on page 70

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