Eyeworld

FALL 2024 | EYEWORLD | 29 C by Ellen Stodola Editorial Co-Director About the physicians Robert Ang, MD Asian Eye Institute Makati City, Philippines Nicole Fram, MD Advanced Vision Care Los Angeles, California corrected vision and quality of vision." He add- ed that the presbyopia capability is the bonus. Other presbyopia-correcting IOLs using diffrac- tive, wavefront-shaping, or spherical aberration induction optics can worsen quality of vision and photic phenomena by inducing additional aberrations. "The IC-8 Apthera is my preferred lens choice for post-refractive eyes," Dr. Ang said. "I have used this lens in clinical studies over 8 years and commercially for 1 year." Dr. Fram said that one of the exciting things about this concept is that the pinhole effect can also help patients with higher order aberrations (HOAs). "HOAs are the irregularities of the light rays as they hit the eye on whatever interface, and it got us thinking of some off-label use of this technology," she said. The idea would be if you create a pinhole effect, you can reduce the higher order aberra- tions, Dr. Fram said "We found that there's this whole population of patients where we were saying, 'You could get a PKP or DALK, wait a year, then do the cataract surgery and hope you don't need a contact lens after for your best T he IC-8 Apthera (Bausch + Lomb) was approved by the FDA in 2022. Since then, many physicians have incor- porated it into their practice. With increased experience, some are discov- ering ways to apply this technology off label. Nicole Fram, MD, and Robert Ang, MD, dis- cussed their experience using the lens, including ways that it can apply to patients who previous- ly had limited options, particularly those with irregular astigmatism. The on-label indication is to put it in the non-dominant eye for extended depth of focus, Dr. Fram said. "They found the sweet spot in the FDA trial to be a target of –0.75 D, which typically achieves good uncorrected distance to 20/25 or 20/30 but also allows for the ability to read at intermediate," she said. "The only caveat is there should be counseling about the dimming that can happen in low light. As you create a pinhole effect, you can see light and some contrast, but it's mainly relevant in low light settings." Although Dr. Fram is using small aper- ture technology mainly in eyes with aberrated corneas, one can also use this technology for pa- tients with regular corneas but who might need some extended depth of focus (EDOF) and are not a candidate for an EDOF IOL or a diffractive technology. "Another application for the IC-8 Apthera is in the circumstance where you're not sure about the exact axis of the astigmatic correction and you need a forgiving technology," she said. Dr. Ang, who practices in the Philippines, noted the approval in the U.S. for implantation in the non-dominant eye. The IC-8 Apthera has two unique features that occur simultaneously, he said. Small aperture optics can extend depth of focus and therefore can be used in presby- opia correction during cataract surgery similar to other EDOF IOLs. Secondly, small aperture optics filter out aberrations, especially from complex corneas, which distinguish it from any other IOL. "Most of my colleagues who have used the IC-8 Apthera find its utility in managing post- refractive surgery eyes, such as previous RK, PRK, LASIK," he said. "The aberration-filtering feature maintains or even improves distance On- and off-label indications for small aperture technology continued on page 30 IC-8 Apthera IOL in a post-LASIK eye Source: Robert Ang, MD

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