Eyeworld

EW CATARACT 34 September 2017 PowerVision The FluidVision accommodating IOL by PowerVision (Belmont, Califor- nia) contains a small amount of fluid that moves in response to the natural muscle forces in the eye. Future of presbyopia treatment According to Dr. Devgan, the best presbyopia treatment will be restor- ing accommodation with an IOL. "The cornea is not the source of presbyopia. Instead, it's the human lens. Everyone over the age of 50 will experience presbyopia. You can plot with a linear curve the amount of accommodation versus age. It's so accurate that when people came here through Ellis Island from other countries and didn't know their birthday or how old they were, they checked their accommodation and from that estimated the person's age," he said. EW Editors' note: Dr. Devgan has financial interests with LensGen. Dr. Donnenfeld has financial interests with LensGen and Elenza. Contact information Devgan: devgan@gmail.com Donnenfeld: ericdonnenfeld@gmail.com Device focus by Michelle Stephenson EyeWorld Contributing Writer Elenza Elenza (Roanoke, Virginia) is devel- oping the Sapphire AutoFocal IOL. This next-generation accommodat- ing IOL uses a combination of liquid crystal chemistry, electricity, and integrated circuitry to create smart optics. The technology includes an electroactive switchable element that automatically adjusts focusing power electronically to maintain constant focus for different work and light environments. The lens is controlled by a micro-sized power cell, which has an expected 50+ year rechargeable cycle life. "There is a small battery built into the IOL that allows the lens to change its refractive index from near to far," Dr. Donnenfeld said. "This is a good feature because it doesn't rely on any aspect of the body's function. That has been the prob- lem with IOLs. Ciliary bodies can't be counted on to move, or there may be concerns about the capsule contracting. This lens removes those concerns. For me, this is a science project, but a project that has great potential going forward. I think this will become the lens of the future, but it is probably 10 years away. I think this is the one true mecha- nism that will work very well." way of solving these problems is to mimic Mother Nature. The Lens- Gen design mimics human nature, and the curvature of the IOL will increase, therefore increasing its power," he said. Eric Donnenfeld, MD, Rock- ville Centre, New York, agreed that the LensGen Juvene AIOL looks promising. "This fluid-lens works by changing shape in the eye in a similar way to how the natural lens works. What makes it special is that it is a two-lens system. One of the lenses, the base lens, serves as a reg- ular IOL, so it has all of the aspects of a standard, monofocal IOL. You then place the fluid-lens accommo- dating portion into the base lens portion, and that allows you to put the lens in through a smaller inci- sion and allows the lens to become more functional. The two-lens sys- tem also retains the volume of the capsule, which maximizes refractive stability, and an open capsule has been shown to reduce the incidence of PCO. Hopefully, this will be developed over the next couple of years and will become more readily available. This is the IOL that I think is the most exciting for the short- term treatment of presbyopia," he said. A glance at promising lenses in the works C rystalens (Bausch + Lomb, Bridgewater, New Jersey) remains the first and only FDA-approved accom- modating IOL. Currently, companies are working to design an IOL that provides reliable accommo- dation, and several promising lenses are in the pipeline. LensGen LensGen (Irvine, California) is developing Juvene, which is the first modular, fluid-optic accommodating IOL. It provides accommodation by mimicking the eye's natural accom- modation process to change shape and adjust focus. "I was the first person to implant that lens in Panama in 2015," said Uday Devgan, MD, Los Angeles. "We've since done dozens of patients, and we're starting up a large trial soon." With the Crystalens first-genera- tion debut, the optic moved forward and backward. "That didn't work because that's not how a human lens works. The lens in a younger person's eye can accommodate a lot, but it doesn't move front to back. The lens changes curvature. The best Accommodating IOLs in the pipeline The LensGen accommodating IOL Source: Eric Donnenfeld, MD Like us on Facebook: facebook.com/ CorneaSocietyUniversity Find us on social media CORNEA SOCIETY UNIVERSITY (CSU), the newest online educational initiative geared toward cornea fellows and young physicians

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