Another approach for presbyopia on the horizon

New Orleans-NuLens Ltd., a company formed 2 years ago in Herzliya Pituach, Israel, has developed a new accommodative IOL technology that offers more than 10 D of accommodative power, according to Joshua Ben-Nun, MD, chief scientific officer, NuLens, who spoke at a breakfast session during the American Academy of Ophthalmology annual meeting.

The company has tested a prototype IOL in research trials in monkeys with the help of VISSUM-Instituto Oftalmologico de Alicante under the guidance of Jorge L. Alio, MD, PhD, and the veterinary facilities at the Miguel Hernandez University in Alicante, Spain. According to their primate data, the new accommodative lens was able to provide more than 30 D of accommodation, noted Dr. Ben-Nun, who is an experienced vitreoretinal surgeon.

The accommodating lens prototype is implanted after cataract removal and "the lens capsule is allowed to collapse creating a 'capsular diaphragm' reaching from the ciliary process through zonuli, collapsed lens capsule, zonuli, and ciliary process again," according to the company's literature. The lens has an anterior reference plane and posterior aperture near the nodal point.

The PMMA haptics are fixated in the ciliary sulcus and angled toward the capsular diaphragm. The optic consists of a small chamber filled with flexible silicone gel and a posterior "piston" has an aperture in the center that allows the silicone to bulge with forces generated by the capsular diaphragm. The optic is 5 to 6 mm long and 2 mm thick. The entire lens measures 12 to 13 mm in length, Dr. Ben-Nun said.

The researchers tested the functional capability of the prototype to see how monkeys behave with and adapt with the lens. A video demonstrated the ability of two monkeys, one with induced myopia of -13 D and the other with induced hyperopia of +8 D, to see and retrieve a peanut with shell, a peanut without shell, and a quarter size peanut after receiving the lens in one eye. The monkey's second eye was sutured closed.

The hyperopic monkey had no difficulty retrieving the different sized peanuts a few days postop. The myopic monkey had some difficulty at first but later was able to accommodate as shown in the video.

The company is developing a human prototype, which will lead to the introduction of a "real accommodative IOL," Dr. Ben-Hun said.

Members of the NuLens Scientific Advisory Board included Dr. Alio, I. Howard Fine, MD, Doug Koch, MD, Emanuel Rosen, and Richard L. Lindstrom, MD.