Eyeworld

129 EW REFRACTIVE March 2018 the lens is healed into position, we can fix any remaining residual re- fractive error based on the manifest refraction. Things like surgically in- duced astigmatism, posterior corneal curvature, and effective lens position are all taken into account in the manifest refraction. Then we adjust the shape of the lens itself." EW Editors' note: Dr. Berdahl, Dr. Mill- er, and Mr. Freeman have financial interests with RxSight. Dr. Lindstrom has financial interests with Alcon (Fort Worth, Texas), Bausch + Lomb (Bridge- water, New Jersey), Carl Zeiss Meditec, Johnson & Johnson Vision (Santa Ana, California), and RxSight. Dr. Mamalis has no financial interests related to his comments. Contact information Berdahl: john.berdahl@vancethompsonvision.com Freeman: rfreeman@rxsight.com Lindstrom: rllindstrom@mneye.com Mamalis: nick.mamalis@hsc.utah.edu Miller: kmiller@ucla.edu Dr. Lindstrom thinks the Light Adjustable Lens will allow surgeons to create a premium monovision channel. "We don't have that to- day," he said. "We have multifocals (3% or 4% of the market), extended depth of focus IOLs (2% or 3%), and accommodating IOLs (maybe 1%). Approximately 25% of U.S. IOL patients are monovision patients. To hit the monovision just right, we would love to have an adjustable IOL where we can make the distance sight plano. In the non-dominant, near eye, we would over refract and maybe try a contact lens to decide the ideal preferred near refraction. Then in the office, we could make the adjustment. That is a big opportunity." Dr. Berdahl said that it is incred- ibly promising technology. "It will allow all surgeons to achieve exqui- site outcomes because we don't have to rely on the estimations that we make preoperatively to get the right lens in place and estimate the effec- tive lens position," he said. "Once surgeon can do, and not require surgeons to train to become corneal refractive surgeons. This is some- thing we all want. When you survey ophthalmologists, they all want it." When the Light Adjustable Lens is launched in the U.S., Dr. Lind- strom thinks that the first patients will be monovision patients. "A significant number of surgeons like to do monovision, which is a very demanding procedure as far as refractive outcome, particularly in the distance eye," he said. "If a surgeon is going to do monovision, the distance eye needs to be dead on. There's a little bit more forgive- ness in the near eye, but everyone who has done monovision or fit a monovision patient with contact lenses knows that patients can often appreciate a distance error of even 0.25 D. With contacts, it's easy to adjust the power up and down a lit- tle to get it just the way the patient wants it. However, IOLs have been more challenging." In fact, they were like LASIK out- comes in terms of uncorrected visual acuity." Dr. Mamalis added a few more criteria: "Patients must have a clear cornea. Significant corneal scarring will disrupt how the laser can treat the lens. Second, the eye must dilate widely enough to treat the entire lens optic." The wait is over Richard Lindstrom, MD, Minne- apolis, said that he and many other surgeons have been waiting for years for an adjustable IOL that does not require surgery on the cornea. "Of approximately 10,000 cata- ract surgeons in the United States, only about 2,500 are comfortable performing PRK or LASIK. Despite advances in IOL power formulas and biometry with the IOLMaster [Carl Zeiss Meditec, Jena, Germany] and LENSTAR [Haag-Streit, Koniz, Swit- zerland], we are still in the 70–90% range of patients who are within 0.5 D of target. To have an outstanding outcome, especially in the premi- um channel, with monovision, multifocal, toric, accommodating, and extended depth of focus lens implants, we need to be within 0.5 D of target and within a few degrees of the appropriate meridian. We're not able to get there reproducibly, so we would like to have a minimally invasive way to adjust the lens pow- er," he said. Dr. Lindstrom added that he would love to see more than 90% of patients be within 0.5 D of tar- get. "The recently FDA-approved first-generation RxSight implant hit those targets," he said. "I think the numbers were 92% within 0.5 D of target, and this was a study that was done with a first-generation product a few years back. RxSight is now working on a second-gener- ation product, which shows prom- ise to move into the middle 90%, which are LASIK-like outcomes. We would like to have LASIK-like outcomes with our cataract surgery, even though it might require a laser adjustment at some time in the postoperative period. Additionally, we would like the adjustment to be minimally invasive and in the office, be something that any cataract Light Adjustable Lens Source: Roy Freeman

• Blank Page
• Blank Page (1)