Eyeworld

EW REFRACTIVE SURGERY 54 February 2015 in case the patient is not happy, we can change the values with another adjustment." Dr. Lehmann said the lens is "perfect" for the post-laser vision correction patient. The ability to adjust the lens after the initial sur- gery takes a considerable amount of pressure off the surgeon, he said. All refractive adjustments occur "under active fixation" so lens decentration and lens tilt are not issues, as all the adjustments "are applied according to the line of sight. Even cylindrical adjustments can be done safely and precisely a few days after implantation," Dr. Hengerer said. Dr. Lehmann said a "study- related" disadvantage of the lens is the number of postop visits. "In the clinical study, we have to do 2 adjustments and 2 lock-ins, so there are 4 visits, 3 days apart," he said. "Future versions of the lens will be able to get that down to 2 to 3 visits." Dr. Wiley concurs, adding a logical argument for some patients is to just implant a monofocal lens, wait 3 months, and perform LASIK for any residual refractive error at that point. The lens is a 3-piece design with a silicone optic, "so there are differences from a single piece acrylic design/material. The incision size is 3.0–3.5 mm, which may seem large if surgeons are routinely doing 2.0–2.5 mm incisions," Dr. Jones said. But another potential upside to the lens is that it obviates the need (and expense) of intraoperative aberrometry. "Currently, we have so many ways of measuring the eye before and during surgery, yet with all of these expensive devices we still lack the precision in refractive outcomes that we desire (and that some pa- tients demand). The LAL may make current intraoperative and preoper- ative measurements irrelevant if we can adjust the lens noninvasively, after surgery," Dr. Lehmann said. Learning curves Dr. Hengerer said learning curves are on the low side; the LAL is a silicone type IOL with an optic diameter of 6 mm and an overall length of 13 mm. It is available from 10 D to 30 D. It can be implanted through an incision size of 2.9 mm using a dis- posable injector system, he said. Attention does have to be paid, however, "while the lens is entering the anterior chamber as silicone lenses expand faster than acrylic ones. Using a medium viscous OVD in the anterior chamber can help to slow down the extraction in a safe way," he said. Dr. Jones recommends surgeons use smaller incisions for the cataract removal and then enlarge the inci- sion for the implantation. "Once the lens is in the capsular sac, I prefer to use bimanual I/A for viscoelastic removal as this avoids manipulation of the [now] larger incision," he said. "I don't have to switch to a larger infusion sleeve on the coaxial I/A tip to fill the larger incision as the bimanual handpieces work through paracenteses." Because the LAL has unpolymer- ized macromers in a silicone matrix, it's "a lot softer than a typical IOL," Dr. Lehmann said. "Traditional sili- cone lenses can be fairly rigid." Each light treatment, or "ad- justment," of the lens creates a diffusion gradient through selective polymerization, causing a shift in the remaining unpolymerized macromers that changes the shape of the IOL, creating a more "plus" or "minus" lens. Any pattern can be programmed in a light treatment, including correction of astigmatism. Think of the adjustments as "activating" the polymers, Dr. Wiley said. Drawing them to the center results in a myopic shift and subtly changes the shape of the lens, he said. Simply put, "this lens and asso- ciated adjustments permit the best possible refractive outcome of any technology," Dr. Jones said. EW Editors' note: Drs. Jones, Lehmann, and Wiley are investigators for the U.S. studies, but do not have any financial interests related to their comments. Dr. Hengerer currently has financial interests with Calhoun Vision; he did not have financial interests during the period in which he conducted clinical studies on the lens. Contact information Hengerer: Fritz.Hengerer@kgu.de Jones: jasonjonesmd@mac.com Lehmann: lehmann@focalpointvision.com Wiley: drwiley@clevelandeyeclinic.com An update continued from page 53

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