Eyeworld

SUMMER 2025 | EYEWORLD | 25 C CHANGING MINDSETS About the physicians Ashraf Ahmad, MD Cataract, Cornea & Refractive Surgery Harvard Eye Associates Laguna Hills, California Alice Epitropoulos, MD Central Ohio Eye & Plastic Surgery The Eye Center Columbus, Ohio Nicole Fram, MD Advanced Vision Care Los Angeles, California Huck Holz, MD Kaiser Permanente Santa Clara, California Robert Weinstock, MD Medical Director Eye Institute of West Florida Regional Medical Director EyeCare Partners Largo, Florida Dagny Zhu, MD Medical Director and Partner NVISION Eye Centers Rowland Heights, California disinhibited during surgery and move their eyes, body, or both, Dr. Holz said. "This is dan- gerous for patients and not only frustrating but extremely stressful for surgeons. It seems to be the case that the patients who have incomplete zonule support also have frontal cortex disin- hibition and are therefore prone to movement under local MAC," he said. "In addition, soon enough we will enter the era of robotic surgery. I am confident in this because we only have two opposable thumbs, whereas machines may have many. This type of equipment will undoubtedly require extremely stable patients." Dr. Holz would like to see the development of a local motor neuron blockade system to inhibit movement while in surgery and make surgery safer for patients. "This could be used to inhibit movement of the eye and orbicularis," he said. Dr. Holz added that there are a few ways to do this. He suggested electrical and mag- netic techniques, noting transcranial magnetic stimulation, which can be used to temporarily disrupt motor neuron activity in a targeted area of the brain. Or nerve blocks with electrical stimulation could be used, and some devices use electrical impulses to interfere with motor neuron signaling. "Development of such a product would make surgery far safer for patients and less stressful for surgeons," he said. Nicole Fram, MD Dr. Fram suggested new products she'd like to see in the cataract refractive and cornea fields. "My request in the cataract refractive world would be a single-piece and 3-piece, 7-mm optic with a low index of refraction and an edge de- sign that would reduce dysphotopsia," she said. "I would also have this lens be adjustable with the ability to wavefront match corneal higher order aberrations." Her request in the cornea world would be for an emphasis on limbal stem cell restoration. "This is an ignored area that is critical to success with any transplantation surgery," she said. O phthalmology is constantly innovat- ing and evolving to new and unmet needs in the clinic and OR. EyeWorld asked members of its Cataract Editorial Board and members of the ASCRS Cataract Clinical Committee to weigh in on: If I could ask industry to produce one new product, this is what it would be and why. Alice Epitropoulos, MD Dr. Epitropoulos suggested the need for a next-generation adaptive multifocal IOL with smart light filtering. While the newest trifocal technology has greatly improved the range of vision for cataract patients with less dysphotopsias, Dr. Epitropou- los said that challenges still exist—particularly with visual disturbances like halos, especially in low-light conditions. An IOL that could automatically adjust its focus based on the lighting conditions would be a major breakthrough, she said. "A smart multifocal IOL that integrates a light-sensing technology that dynamically adjusts the lens power based on ambient light, optimizing near, intermediate, and distance vision in real time would be the holy grail." For example, Dr. Epitropoulos said, in bright light, it could provide sharper distance vision; in dim light, it could shift to improve near and intermediate focus. The lens could also feature advanced filtering to reduce glare and halos without affecting contrast sensitivity, making it ideal for nighttime driving. "This product would address two of the main concerns that patients have with multifo- cal IOLs—visual disturbances and adaptability in changing lighting environments—offering them a seamless and natural visual experience post-surgery. It would also give surgeons more flexibility in offering customized solutions to patients based on their lifestyle and needs." Huck Holz, MD Dr. Holz would like to see a local motor neuron blockade system to inhibit movement during surgery. Most surgeons operate under topical MAC, and it is not unusual for people to become If I could ask industry to produce one new product … continued on page 26

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