A variety of approaches are commercially available or in development that allow refractive adjustments after cataract surgery, including changes in sphere, cylinder, asphericity, and multifocality
This article was reviewed by Burkhard Dick, MD
Available and emerging technologies are addressing the need for solutions to the persistent problem of refractive surprises after cataract surgery, according to Burk-hard Dick, MD, PhD.
Two multicomponent IOLs (PreciSight, InfiniteVision Optics; Harmoni Modular IOL, ClarVista) and the light-adjustable lens (LAL, RxSight) are now on the market in some countries, and four companies are developing approaches for inducing refractive index changes using a femtosecond laser, said Dr. Dick, professor of ophthalmology, Ruhr University, and chairman, The University Eye Hospital Bochum, Bochum, Germany.
Sharing his personal perspectives on the light-adjustable lens, Dr. Dick noted that there is now more than 10 years of clinical experience with this technology, and an upgraded version is now available commercially in Europe that is showing great success.
“A vast amount of experience underscores the value of this three-piece silicone lens whose refractive power can be changed within a few weeks after cataract surgery by specifically targeted UV irradiation,” he said. “I consider the light-adjustable lens a great option to improve refractive outcomes and advance patient care.”
The upgraded light-adjustable lens platform features added UV protection, is implanted with a proprietary injector that allows introduction through incisions ≤ (</=) 2.75 mm, and is adjusted with a new light delivery device. This offers improved ergonomics, a 10-fold reduction in retinal UV irradiance, and new optical patterns.
“The new platform allows for earlier noninvasive post-implantation adjustment and less lock-ins, and it can create an extended depth of focus pattern, induce negative asphericity, and be used to design individually adjustable mini-monovision,” Dr. Dick said.
The safety and performance of the new light-adjustable lens was investigated in a multicenter European study that enrolled 100 eyes of 50 patients with 0.5 to 3 D of preop keratometric astigmatism. The results demonstrated the safety and efficacy of the upgraded light-adjustable lens technology, Dr. Dick said.
“More than 70% of eyes achieved 20/20 or better UCVA, which represents a twofold improvement over the outcomes achieved with toric IOLs, and the accuracy to target refraction for spherical equivalent and cylinder was exceptionally high, matching LASIK outcomes,” he pointed out.
“In addition, the incidence of both glare and halo were very low.”