A wealth of new IOLs are

New IOL tech: A lot in the pipeline

Options include EDOF, adjustable modular and accommodating designs. Howard Larkin reports

Arange of new technology intraocular lenses addressing everything from presbyopia to refractive surprise are on the market or on the horizon, Sumit Garg MD, said at the ASCRS Virtual Annual Meeting 2020. He provided a rundown of several.

EDOF MONOFOCAL Tecnis Eyhance (Johnson & Johnson Vision, Santa Ana, California, USA), now available in Europe and elsewhere outside the USA, is a refractive technology monofocal lens that provides one line of improvement in intermediate vision. This is achieved with a progressive power change and higher order aspheric surface that add power toward the centre of the lens. The lens is virtually indistinguishable from the conventional Tecnis monofocal lens and has a glare profile similar to monofocal lenses, said Dr Garg, of the Gavin Herbert Eye Institute, University of California, Irvine, USA.

EDOF WAVEFRONT AcrySof IQ Vivity (Alcon, Fort Worth, Texas, USA) extends depth of focus using a proprietary non-diffractive wavefront altering design, creating a continuous range of vision across distance and intermediate range. The lens’s visual disturbance profile is similar to a monofocal lens, with the majority of patients not bothered by haloes, glare or starbursts. Approved by the FDA in February, Vivity is available in Europe and launches in the USA this year.

SMALL APERTURE IC-8 (AcuFocus, Irvine, California, USA) uses a small aperture to extend depth of focus. The pinhole optics also provide a benefit in aberrated corneas, Dr Garg said. Available outside the USA, IC-8 recently completed enrolment for its FDA clinical trial.

EDOF + MULTIFOCAL Tecnis Synergy (Johnson & Johnson Vision, Santa Ana, California, USA) combines the diffractive extended depth of focus

What’s exciting about this lens is patients did not complain of dysphotopsias Sumit Garg MD

(EDOF) technology of the Symfony with multifocality to create a continuous range of vision from distance to 33cm, without the drop-out at intermediate distances seen with many previous multifocal designs, Dr Garg noted. The lens is available in Europe, Australia and New Zealand.

EnVista trifocal (Bausch + Lomb, Rochester, New York, USA), available in Europe since 2017, is in FDA clinical trials for registration in the USA, Dr Garg said.

MODULAR IOLS Omega Gemini refractive capsule (Omega Ophthalmics, Lexington, Kentucky, USA) consists of a capsule-filling module into which various lenses can be inserted, potentially allowing lenses exchange in cases of residual refractive error or patient intolerance of a multifocal or other lens type. The modular design also allows for placement of drug delivery or sensors in the capsular bag space, Dr Garg said.

Harmoni (ClarVista Medical, Alcon, Fort Worth, Texas, USA) is a modular IOL consisting of a base with haptics similar to a conventional IOL, but the optic snaps in and can be exchanged, Dr Garg said.

TRUE ACCOMMODATING IOLS FluidVision (PowerVision, Alcon) is a true accommodating IOL design consisting of a clear deformable optic filled with fluid attached to peripheral reservoirs that change the shape and refractive power of the lens in response to accommodative effort. The lens is in development, Dr Garg said.

Atia Vision (Shifamed, Campbell, California, USA) is a modular dual optic accommodating lens design in which the accommodating engine and posterior optic are implanted in the capsule with and exchangeable fixed front optic. A hydraulic multiplier changes the shape of the posterior lens in response to accommodative effort, Dr Garg said.

Opira (ForSight Labs, Menlo Park, California, USA) is a sulcus-based accommodating IOL that fixes haptics in the capsulorhexis, putting them in direct contact with the ciliary body. Contractions pump fluid into the anterior optic, changing its shape and power, Dr Garg said.

Juvene (LensGen, Irvine, California, USA) is a fluid-filled modular accommodating IOL with a base that fits into the capsule, changing the shape and power of the removable optic, allowing continuous vision from distance to near in response to accommodative effort, Dr Garg said. He presented a case from the Grail exploratory study in Mexico.

A 65-year-old female had Juvene IOLs implanted in both eyes through 3.0mm incisions after cataract removal. Six months after surgery she had uncorrected distance visual acuity of 20/25-1 in the right eye and 20/25-2 in the left, with refractions of -0.25D-0.75Dx065 and -0.5D-0.5Dx70 respectively. Binocularly distance corrected, she achieved 20/16+1 at distance, 20/20+2 intermediate and 20/20-1 at near.

Similarly, mean distance-corrected binocular defocus for 15 patients implanted with the lens was 20/16 distance, 20/25+ intermediate at 66cm and 20/32+ near at 40cm.

“What’s exciting about this lens is patients did not complain of dysphotopsias,” Dr Garg said. In addition, PCO formation has not been observed with this lens clinically, and the capsule has remained much clearer than conventional IOLs in contralateral eye rabbit studies.

“There are many innovative designs coming down the pike. The creative optics and designs are certainly exciting. I look forward to the opportunity to use them in my patients,” Dr Garg concluded.