Topical approach to presbyopia
Development of topical treatments for presbyopia is also continuing with two products in clinical trials—lipoic acid choline ester 1.5% (EV06, Novartis) and a formulation introduced by the late Lee Nordan, MD, known as Liquid Vision (Presbyopia Therapies). EV06 aims to restore crystalline lens flexibility. Liquid Vision combines a strong miotic (aceclidine) to create a superpinhole effect with a cycloplegic (tropicamide) to manage accommodation.
Looking ahead, Dr. Donnenfeld believes that there are also some promising accommodating IOLs in development, including the LensGen Advanced IOL (LensGen) and the FluidVision accommodating IOL (PowerVision).
Other IOL news
In 2017, Bausch + Lomb announced a new version of its enVista IOL—the MX60E—that features a new material with better unfolding characteristics.
“Surgeons will find that the new enVista unfolds just like a Tecnis or AcrySof IOL, if not a little easier, because it does not seem to stick at all,” Dr. Packer said. “This new material will be very important for getting predictable outcomes with a toric model.”
Dr. Osher noted that the small-aperture lens designed by Brazilian ophthalmologist Claudio Trindade, MD, for treating irregular astigmatism and/or intolerable glare (XtraFocus Pinhole Implant, Morcher) is coming to Europe. It is intended for ciliary sulcus implantation as a piggyback lens. The small aperture lies within a black hydrophobic acrylic material that blocks incoming visible light, but is penetrable by infrared light and so allows retinal examination. Dr. Osher performed the first implantation of this device in the United States and has been impressed with the outcomes.
European surgeons also saw the introduction of a disposable, preloaded, automated delivery system (AutonoMe, Alcon Laboratories) that allows one-handed insertion for the new Clareon IOL through an incision as small as 2.2 mm.
In the future, an adjustable IOL may be the best answer to addressing patient dissatisfaction related to residual refractive error, Dr. Osher said. One technology he is watching is the Perfect Lens that can have spherical aberration, asphericity, toricity, and multifocality adjustments made in vivo by treatment with a femtosecond laser.