Article

Accommodating IOL designs will continue to improve

Although expressing different levels of enthusiasm for accommodative IOLs, clinicians debating the merits of this technology agreed that the devices have promise and said they look forward to improvements and new designs.

Key Points

I. Howard Fine, MD, clinical professor of ophthalmology, Oregon Health & Science University, Portland, and Sandy T. Feldman, MD, MS, Clear View Eye and Laser Medical Center, San Diego, weighed the merits of accommodating IOLs in presentations during the Refractive Surgery Subspecialty Day here at the American Academy of Ophthalmology annual meeting.

"Multifocal IOLs require no accommodative effort, and that is an advantage, but they do require central nervous system adaptation. They will always have some halos or blur. There is some loss of contrast sensitivity, and they may be a very bad choice for patients with age-related macular degeneration," Dr. Fine said.

The first presbyopic IOL was a foldable silicone multifocal IOL (Array, Advanced Medical Optics [AMO]), an aspheric design with the entire refractive sequence in each of five concentric zones. A pivotal clinical trial showed that 41% of patients in whom the lens was implanted bilaterally required no spectacles, although spectacle independence was not guaranteed.

In Dr. Fine's experience with refractive lens exchange in these patients, 44% achieved spectacle independence and saw at least J2 and 20/25. Halos around point sources of light at night have been a common problem with this lens, but this problem tends to improve or resolve over several months, he said.

Over time, IOL technology has improved, and more designs are being tested or on the market. One multifocal lens (Tecnis, AMO) is well accepted in Europe and is undergoing FDA trials in the United States, Dr. Fine said, whereas another lens (crystalens, eyeonics) has FDA approval and achieved very good results in FDA clinical trials and in patients undergoing refractive lens exchange. Another accommodative lens (Akkommodative 1CU, HumanOptics) is available on the international market.

"Theoretical considerations show that a dual-optic IOL that moves in the eye has a higher amplitude of accommodation than a monocular IOL," Dr. Fine said.

Deformable IOLs may be the most promising technology, he continued. One (NuLens, NuLens Ltd.) has a flexible polymer between two plates. With accommodative effort, the polymer is pushed into an aperture in the anterior plate, resulting in a marked change in the curvature and a marked increase in the spherical axis.

Newsletter

Don’t miss out—get Ophthalmology Times updates on the latest clinical advancements and expert interviews, straight to your inbox.

Related Videos
(Image credit: Ophthalmology Times)  ASCRS 2025: Joaquin De Rojas, MD, leverages machine learning model to predict arcuate outcomes
Shehzad Batliwala, DO, aka Dr. Shehz, discussed humanitarian ophthalmology and performing refractive surgery in low-resource, high-risk areas at the ASCRS Foundation Symposium.
(Image credit: Ophthalmology Times) ASCRS 2025: Advancing vitreous care with Inder Paul Singh, MD
(Image credit: Ophthalmology Times) The Residency Report: Study provides new insights into USH2A target end points
Lisa Nijm, MD, says preoperative osmolarity testing can manage patient expectations and improve surgical results at the 2025 ASCRS annual meeting
At the 2025 ASCRS Annual Meeting, Weijie Violet Lin, MD, ABO, shares highlights from a 5-year review of cross-linking complications
Maanasa Indaram, MD, is the medical director of the pediatric ophthalmology and adult strabismus division at University of California San Francisco, and spoke about corneal crosslinking (CXL) at the 2025 ASCRS annual meeting
(Image credit: Ophthalmology Times) ASCRS 2025: Taylor Strange, DO, assesses early visual outcomes with femto-created arcuate incisions in premium IOL cases
(Image credit: Ophthalmology Times) ASCRS 2025: Neda Shamie, MD, shares her early clinical experience with the Unity VCS system
Patricia Buehler, MD, MPH, founder and CEO of Osheru, talks about the Ziplyft device for noninvasive blepharoplasty at the 2025 American Society of Cataract and Refractive Surgeons (ASCRS) annual meeting
© 2025 MJH Life Sciences

All rights reserved.