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EW REFRACTIVE SURGERY 66 June 2016 by Matt Young and Gloria Gamat EyeWorld Contributing Writers opacification and to retain uveal and capsular biocompatibility," Dr. Kohl and colleagues concluded. Both the short-term and long- term opacification studies in rabbit eyes were conducted at the Moran Eye Center, University of Utah, Salt Lake City, and the results supported the premise of the in-human clinical studies that commenced later on. "If the fluid-filled intraocular lens truly fills the capsular bag in a predictable, sustainable fashion, then this lens design may become a viable solution to these problems— at least in some patient subsets," Dr. Sheppard said. "It appears that this type of lens solves the major issues of accom- modating and multifocal IOLs," he concluded. EW References 1. Floyd AM, et al. Capsular bag opacification with a new accommodating intraocular lens. J Cataract Refract Surg. 2013;39:1415–1420. 2. Kohl JC, et al. Long-term uveal and capsu- lar biocompatibility of a new accommodating intraocular lens. J Cataract Refract Surg. 2014;40:2113–2119. Editors' note: Dr. Nichamin has financial interests with PowerVision. Dr. Sheppard has no financial interest related to his comments. Contact information Nichamin: nichamin@laureleye.com Sheppard: jsheppard@vec2020.com to the large haptic elements size, which seems to prevent capsular bag opacification. Further, Kohl and colleagues 2 evaluated the long-term uveal and capsular biocompatibility of FluidVision compared to a hydro- phobic acrylic control IOL using rabbit eyes as well. "Uveal biocompatibility of study and control IOLs was similar in clin- ical and pathologic examinations up to 6 months postoperatively; in the study group, anterior capsule opaci- fication appeared absent and PCO was significantly less than in the control group," they reported in the December 2014 issue of the Journal of Cataract & Refractive Surgery. "At the gross examination at 6 months, central PCO was 0.8±0.5 (SD) in the study IOLs and 3.7±0.4 in the control IOLs (P<.0001, 2-tailed paired t test); histopatholog- ic examination confirmed the rela- tive lack of capsule opacification in study eyes compared with controls and the absence of untoward inflam- matory reaction or toxicity in all eyes," Kohl and colleagues reported. These results have a similar trend as the short-term study. "The accommodating IOL [FluidVision] maintained an ex- panded capsular bag secondary to the large size of the haptic elements without significant contact with the anterior capsule; this appeared to prevent overall capsular bag accommodation by defocus was sta- ble and averaged 3.25 D throughout the 18-month period," he reported. "The monocular best corrected distance visual acuity from 1 month through the 24-month period was found stable at 20/20, while the monocular distance corrected near visual acuity varied from about 20/25 to 20/30; in both cases, ac- commodation by defocus was also stable," he added. "An accommodating lens— when it works—is marvelous for pa- tients and for doctors," Dr. Sheppard said. The vexing problem, Dr. Sheppard noted, is consistency of the effective lens position (ELP). "The accommodating lens has a changing relationship with the capsular fornix as well as the ciliary body as the capsule undergoes normal fibrotic changes; if those parameters can be controlled, most patients with accommodating lenses do well," he said. Capsular bag opacification In a short-term rabbit study, Floyd and colleagues 1 conducted a 6-week follow-up to assess the biocompati- bility and capsular bag opacification of FluidVision. According to the group's findings, capsular bag opacification with FluidVision is remarkably low overall compared with that of a commercially available single-piece hydrophobic acrylic IOLs. "At 6 weeks, the mean posterior capsule opacification (PCO) clinical score was 0.5±0.3 (SD) in the study group and 3.0±0.9 in the control group (P=.001, 2-tail paired t test); anterior capsule opacification was practically absent in the study group and mild in the control group," Floyd and colleagues reported in the September 2013 issue of the Journal of Cataract & Refractive Surgery. "Miyake-Apple posterior view showed a mean central PCO score of 0±0 in the study group and 3.0±1.1 in the control group (P=.001), pe- ripheral PCO score of 0.7±0.4 and 3.5±0.8 (P=.0006), respectively, and Soemmering's ring score of 2.3±0.8 and 7.0±2.8 (P=.01), respectively. Histopathology showed no signs of toxicity in any eye," they reported. Based on these results, the team concluded that FluidVision retained an expanded capsular bag secondary Update on studies of FluidVision IOL S ince IOLs were identified for cataract treatment, there has been an ongoing race toward the creation of the "most natural" lens possible. Accommodating IOLs seem to be closing in on that goal. "Hopefully, this is the future; presbyopic cataract surgery has always been both the holy grail and nemesis for cataract surgeons," said John Sheppard, MD, professor of ophthalmology, microbiology and molecular biology, and clinical direc- tor, Thomas R. Lee Center for Ocular Pharmacology, Eastern Virginia Med- ical School, Norfolk, Virginia. At the 2015 American Academy of Ophthalmology (AAO) annual meeting, clinical results of 2-year ongoing studies of a new, fluid-filled, shape changing, accommodating IOL, FluidVision (PowerVision, Bel- mont, California), were presented. Promising clinical evidence "The FluidVision accommodating IOL gave excellent binocular dis- tance, intermediate, and near visual acuities in the study population evaluated," reported Louis "Skip" Nichamin, MD, medical director, Laurel Eye Clinic, Brookville, Penn- sylvania. "While available data showed that the lens definitely worked for the first year, it is at 24 months when we would expect to see true capsular fibrosis," he added. From the time FluidVision was under investigation, experts were in awe of this novel device's capability of harnessing the eye's natural envi- ronment to work for it. The question that remains re- garding the IOL's long-term perfor- mance is: What would happen once the capsular bag fibroses? "Implantation of FluidVision provides 3 to 4 D of accommodation together with excellent distance, intermediate, and near vision; most importantly, all of these remained stable throughout the 2-year follow- up period," Dr. Nichamin said. "At 18-months of follow-up, the monocular logMAR visual acuities for distance, intermediate, and near were –0.02, 0.08, and 0.24, respectively, and were stable; Clinical trial of new accommodating IOL reveals promising results The FluidVision lens Source: PowerVision

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