From November 18 to 20, 2022, eyecare practitioners from around the world gathered online for Eyes On 2023, a 3 day educational summit offering up to 9 hours of COPE-accredited CE and CME providing the latest innovations in the ophthalmic industry.
Enjoy this presentation from Andrew A. Kao, MD, and don't forget to check out our list of future events!
Please note these videos are provided for review only.
Watch the full lecture on developments in refractive surgery management!
Innovations in laser vision correction
- Small-incision lenticule extraction (SMILE): Currently the fastest-growing LVC procedure with visual results similar to LASIK. There are fewer flap compilations and less postoperative dryness and discomfort. It utilizes a femtosecond laser to create a corneal lenticule extracted through a small incision without a flap.
- Topography-guided LASIK: The WaveLight Topolyzer Vario measures topography and keratometry, allowing for wavefront optimization of the corneal optics and a custom treatment pattern for each patient. In the FDA clinical trial, 92.7% of eyes achieved 20/20 or better uncorrected distant visual acuity (UCDVA).
- Wavefront-guided LASIK technology: This uses the iDesign aberrometer and is performed using a laser to ablate a spatially-variant pattern based on the measurements from the aberrometer. The iDesign combines wavefront analysis with corneal topography to provide a custom treatment pattern for each patient.
- PresbyLASIK: Enhances the corneal depth of focus by creating a multifocal corneal surface. Treatment is pupil-dependent and requires good centration on the pupil; otherwise, it can cause higher-order aberrations such as coma. The Central PresbyLASIK has a central steep area for near vision and is flatter in the peripheral zone for distance. Peripheral PresbyLASIK has central far vision and peripheral in the near zone.
What’s new in lens-based refractive surgery?
Types of phakic intraocular lenses
- Verisyse: A polymethylmethacrylate (PMMA) iris-claw IOL designed for implantation in the anterior chamber. It requires the creation of a peripheral iridotomy.
- Indicated for correction of myopia from -5 to -20D, with <2.5D astigmatism, and anterior chamber (AC) depth >3.2mm with stable refraction.
- Contraindications include <21 years of age, AC depth <3.2mm, abnormal iris/cornea, pregnant or nursing patients, and those with a decreased epithelial cell count.
- Visian EVO ICL: The lens is placed between the crystalline lens and the iris. It is made of collamer, a copolymer of hydroxyethyl methacrylate and porcine collagen. EVO/EVO+ ICLs have a central hole, precluding the need for a laser peripheral iridotomy.
- Indicated for correction/reduction of myopic astigmatism from -3 to -20D, with 1 to 4D astigmatism at the spectacle plane, AC depth of 3mm, and stable refractive history.
- Contraindications include AC <3mm, narrow-angle, pregnant/nursing patients, <21 years of age, moderate or severe glaucoma, and a decreased epithelial cell count.
- Visian EVO+ with extended depth of focus (EDOF) ICL: Based on the EVO+ technology, this lens has an aspheric design to provide up to +2.0D of extended depth of focus.
- A multicenter trial with 35 subjects with the EVO+ EDOF ICL implanted bilaterally showed it was well tolerated. One patient had it explanted due to dissatisfaction with distance vision, but 91% of patients were satisfied with their vision, and no serious adverse events were noted.
Refractive lens exchange
Presbyopia-correcting intraocular lenses
Diffractive lenses for presbyopes that can be implanted during cataract surgery:
- Restor (Alcon): The first diffractive IOL created in 2005, it has a near-dominant central area with diffractive peripheral rings and +2.5D, +3.25D, and +4D near range.
- Tecnis (Johnson & Johnson): Has an aspheric anterior surface with a posterior surface with diffractive rings and +2.75D, +3.25D, and +4D near range.
Extended depth of field IOLs
- TECNIS Symfony (Johnson & Johnson): The first FDA-approved EDOF IOl was approved in 2016. Posterior echelettes create an achromatic diffractive pattern that elongates the focal point and compensates for the cornea's chromic aberration.
- In a large multi-center trial, >85% of patients achieved spectacle independence, with >90% experiencing no or mild haloes, glare, and starbursts.
- Vivity (Alcon): Approved by the FDA in March 2020 and uses novel non-diffractive design (X-WAVE), resulting in wavefront shaping.
- The FDA trial showed distance visual acuity of 20/25 or better for 89% of patients, intermediate of 20/25, and near 20/40 vision for ~40% of participants.
- IC-8 Apthera (AcuFocus): An EDOF and pinhole IOL that was FDA approved in July 2022 for a refractive target of -0.75D. It uses the pinhole effect to allow central rays to enter the eye while eliminating diverging rays. This reduces the size of the circle of confusion on the retina and increases the depth of field.
- The FDA pivotal trial showed that eyes with Apthera had 2D of EDOF, equivalent distance vision, and superior intermediate and near vision compared to control.
- Synergy (Johnson & Johnson): A hybrid EDOF and multifocal IOL that provides a wide range of continuous vision with excellent near vision. It was FDA approved in May 2021. The lens contains an Optiblue violet light filter and high-resolution lathing to help decrease nighttime haloes and starbursts.
- There is a slightly smaller landing zone for the refractive target, so it’s better to aim slightly hyperopic than myopic when fitting the contacts.
Using this IOL can be a good compromise for patients who might not otherwise be good candidates for presbyopia correction due to other ocular comorbidities.
Light adjustable lens
The RxLAL is FDA-approved for 3 to 4 treatments over a 1 to 2-week period. This must be done up to 17 to 21 days after surgery; then afterward, the lock-in treatment is performed. After the procedure, patients must limit exposure to ambient UV light by wearing UV-blocking glasses indoors and out.
Innovations in refractive surgery management
Laser-induced refractive index change
Modular intraocular lenses
Modular IOLs currently in development include:
- Gemini Refractive Capsule (Omega Ophthalmics): Circular silicone polymer capsule with a 6mm opening at the top and bottom that fills the capsular bag. It is designed to hold a single-piece acrylic IOL with a channel holding haptics in a stable position. This could be used for drug delivery, biometrics, or making IOL exchange easier.
- Juvene IOL (LensGen, Inc): A modular, shape-changing fluid optic IOL.
- Harmoni Modular IOL System (ClarVista Medical): Hydrophobic acrylic base with hydrophobic acrylic optic. The central optic can be exchanged or rotated if needed, and multifocality could be added or removed.
- Atia Vision modular presbyopia-correcting IOL (Shifamed): Has a shape-changing, accommodating base and exchangeable front optic. The base contacts the capsular bag, transferring force from the ciliary muscle to the optic.