Eyeworld

EW FEATURE 67 Final thoughts Because of the multitude of chal- lenges in treating near emmetropes, "I'm not an enthusiast of our cur- rent technologies," Dr. Lane said. "It's the one frontier we've yet to be able to get a good grasp on." For the time being, he discusses monovision LASIK, "which doesn't have any of the risks" of the current lenses, but only a select group of patients will be willing or able to tolerate mono- vision. "There aren't any technologies that are coming shortly that are going to be the be-all and end-all for this group of patients," Dr. Koch said. "There are some promising ap- proaches that are being looked at, but they are all going to have some element of compromise. I think we'll have something much better in 3-5 years. It won't be perfect. I'm an- ticipating it's going to take a lot longer than that to get a really ideal product." Dr. Nichamin believes "within the next 3-10 years, we'll have an explosion in interest in emmetropic presbyopic lens exchange." He even goes so far as to speculate the sur- gery will be office-based, "particu- larly in conjunction with the femtosecond laser." Presbyopia "is an experiential thing, and we all go through it," Dr. Weiss said. "It's much more dis- abling than people initially think." Unless patients are willing to accept wearing progressive bifocals, "they'll just keep looking for something to 'fix' them. Baby boomers don't ac- cept aging." EW February 2011 October 2011 Challenging refractive cases Under the radar S ome companies that have not yet had people on the podium presenting, or had much published about earlier studies, are quietly moving ahead with their twist on a technology that will provide true accommodation. Here, a quick look at two of the companies (information gleaned from public websites and/or news items): AutoFocal IOL (Elenza, Roanoke, Va.) According to Dr. Koch, the lens works via photosensors. The IOL is bat- tery-powered, with two lithium ion batteries that are rechargeable (pa- tients wear a neck brace or a neck pad when sleeping or wear something over their eyes that would externally charge the batteries about once a week). The embedded sensors in the optics detect pupil size; the sensors are programmed to accommodate by detecting convergence in orienta- tion. That, in turn, activates a liquid crystal that generates defractive op- tics to create near vision. The company has said its "electro-active IOLs use a proprietary com- bination of liquid-crystal chemistry, electricity, and integrated-circuitry to create smart optics, which will provide patients with the ability to see more naturally and clearly over the full range of vision. The technology includes an electro-active switchable element that automatically adjusts focusing power electronically, in milliseconds, to maintain constant in- focus vision for various working needs and/or light environments. The lens is controlled by a micro-sized power-cell with an expected 50+ year rechargeable cycle life." AkkoLens (AkkoLens, the Netherlands) AkkoLens has developed a novel accommodating intraocular lens that uses the ciliary muscle to move sliding aspheric surfaces laterally about 0.5 mm, yielding up to 5.00 D of accommodation, according to Dr. Michiel C. Rombach, M.B.A., chief executive officer of the company. The AkkoLens is "made from standard materials and easily posi- tioned in the sulcus via simple and speedy, standard suture-free surgery; the lenses stay stably centered a small distance from the iris," he said in an email to EyeWorld. Multicenter, international studies have shown "significant move- ment of the optical elements in blind eyes; multicenter trials of accom- modation are continuing in seeing eyes." Current trials are ongoing in Spain, Russia, and Belgium, Dr. Rombach added. Dr. Koch said the lenses "respond to ciliary muscle pressure by slid- ing over one another and increasing plus power, giving the patient the ability to read." As the eye converges, the two optics will slide together to increase focus power, he said. Editors' note: Dr. Harton has financial interests with Lenstec, Sonomed Escalon (Lake Success, N.Y.), and STAAR Surgical. Dr. Koch has financial interests with Abbott Medical Optics (AMO, Santa Ana, Calif.), Alcon (Fort Worth, Texas), and NuLens. Dr. Lane has financial interests with AMO, Alcon, and Bausch & Lomb (Rochester, N.Y.). Dr. Nichamin has financial in- terests with PowerVision and Bausch & Lomb. Dr. Weiss does not have any financial interests related to his com- ments. Contact information Harton: 706-233-8502, pharton@harbinclinic.com Koch: 713-798-6443, dkoch@bcm.edu Lane: 651-275-3000, sslane@advancedeyecare.com Nichamin: 814-849-6547, ldnichamin@aol.com Weiss: 858-455-6800, jackweissmd@gmail.com 52-67 Feature_EW October 2011-DL33_Layout 1 9/29/11 4:52 PM Page 67

• Cover