Eyeworld

95 EW FEATURE March 2018 • Current and future IOL choices AT A GLANCE • The only accommodating IOLs with U.S. regulatory approval remain the Crystalens and the Trulign. • Some surgeons use the alternative of mini-monovision to target one eye to plano and the other eye slightly myopic. • Good accommodating lens candidates include those who are distance-oriented and who need sharp night vision. by Rich Daly EyeWorld Contributing Writer Possibilities and limitations of accommodating lens technology in the U.S. M ore accommodating lens options may be coming in sever- al years, but for the immediate future, U.S. surgeons are trying to get the most out of available technology. The only accommodating platform approved for sale by the U.S. Food and Drug Administration (FDA) remains the single pseudo- accommodating plate haptic IOL, which comes in spherical (Crystal- ens, Bausch + Lomb, Bridgewater, New Jersey) and toric (Trulign, Bausch + Lomb) versions. A few new accommodating lens- es are in the pipeline, but it is uncer- tain when they will be commercially available, said Elizabeth Yeu, MD, assistant professor, Eastern Virginia Medical School, Norfolk, Virginia. "The various platforms are quite unique, some employing electricity to initiate accommodation, and dif- ferent methods to create an accom- modation with fluid or optic shifts to provide greater near vision," Dr. Yeu said. Future options that are furthest along in clinical trials are lenses from PowerVision (Belmont, Califor- nia) and AkkoLens (Breda, the Neth- erlands), said Richard Lindstrom, MD, founder and attending surgeon, Minnesota Eye Consultants. Ad- ditional lens options are at earlier stages of clinical trials. "Of special interest is Alcon [Fort Worth, Texas]/Google [Moun- tain View, California] and Elenza [Roanoke, Virginia] working on an electronic IOL," Dr. Lindstrom said. One new accommodating lens that completed its first phase of FDA enrollment was developed by the Crystalens inventor, J. Stuart Cumming, MD, said Robert Wein- stock, MD, director of cataract and refractive surgery, The Eye Institute of West Florida. Until such alternatives are approved, some surgeons have supplemented the two approved accommodating lenses with mono- focal IOLs that give broader depth of field because of the way they are designed and their spherical aberra- tion, Dr. Weinstock said. He noted that the Akreos AO platform (Bausch + Lomb) has zero induced spherical aberrations. "Technically, they have more depth of field than a lens that has negative spherical aberration in- duced," Dr. Weinstock said. Some surgeons use the alterna- tive of mini-monovision, or blended vision, Dr. Weinstock said. That approach targets one eye to plano and the other eye slightly myopic in order to improve the depth of field and decrease dependency on reading glasses. The Crystalens provides most surgeons about 1–1.5 D of accom- modation, Dr. Weinstock said. "That means the patient still needs a pair of light reading glasses for very small print like in a newspa- per or paperback book," Dr. Wein- stock said. "But for smartphones, the dashboard of your car, midrange eating, and a lot of the more func- tional vision, it does well." Good and bad candidates Since the central optic of the available accommodating lenses are monofocal, many more eyes are candidates than would match with available multifocal or extended depth of focus IOLs, Dr. Yeu said. Good candidates for the accom- modating lenses are patients with realistic expectations, expressed un- derstanding that reading glasses for near vision will likely be necessary, tolerance of mini-monovision, and vision needs that are more within the intermediate realm, such as computer use, Dr. Yeu said. "Dry eye disease should be controlled, at best, and only mild to moderate at worst," Dr. Yeu said. "Patients can have mild macular or retinal pathology, but expectations must be clearly delineated as to prognosis of visual potential." Dr. Weinstock said the best candidates are hyperopes who wear glasses all of the time and who have maximized their accommodation over the years trying to fight their hyperopia and presbyopia. Getting the most out of available accommodating options continued on page 96

• Blank Page
• Blank Page (1)