I consider the innovative and revolutionary accommodative IOL from HumanOptics AG (Erlangen, Germany), called the Akkommodative 1CU (pronounced “I see you”), to be the lens of choice for the future. It is the result of several years of research based on advanced and complex computer simulations. The lens' functionality was born from the theory of accommodation by H. Helmholtz, MD, who proposed a revolutionary mechanism involving both lens surface and the ciliary body in accommodation.
The lens is a hydrophilic acrylic foldable model with a sharp edge (Figure 1). Its optic size dimension is 5.5 mm, a size that does not induce halos or glare, regardless of light condition. The lens' current available power ranges are from +16 D to +20 D. The company suggests a 5-mm circular, centered, continuous curvilinear capsulorhexis. In my clinical experience, this size works very well and protects the IOL from any decentration. A larger capsulorhexis can interfere with the lens' accommodative capabilities, and a smaller one can interfere with the ACO biological process. The 1CU can be either folded or injected; I have performed successful surgeries using the HumanOptics injector RS 210.
History
Michael Küechle, MD, PhD, of the Eye Clinic at the University of Erlangen-Nuremberg, Germany, performed the initial implantation approximately a year and a half ago. Since then, Thomas Neuhann, MD, PhD (Munich), Manfred Tetz, MD, PhD (Berlin), and many other leading surgeons have also implanted the lens. There are several studies being conducted in Europe and other countries involving more than 10 surgeons who are enthusiastic about their first clinical results. In particular, a multicenter study group in Italy has attained excellent results. Of the approximately 30 1CU lenses they have implanted, more than 85% have obtained distance UCVA of 20/25 and J2, or better. Currently, FDA studies in the US have not yet begun.
Differences FROM the C&C CrystaLens
The technology of the 1CU is based on the continued functionality of the ciliary muscle, following surgical removal of the natural lens. The C&C CrystaLens (C&C Vision, Aliso Viejo, CA) works by the contraction of the ciliary muscle, which changes pressure dynamics to push the vitreous body toward the capsular bag with the IOL inside. C&C asks the surgeon to use 1% atropine drops postoperatively to minimize lens movement so the haptics can maintain proper position as the anterior and posterior capsule leaflets fuse around them. Another basic difference between the lenses is that the optic plate of the CrystaLens is smaller than that of the 1CU (4.5 mm versus 5.5 mm).
LENS centration and accommodation
During surgery, there are several clinical signs that can indicate to the surgeon that the IOL is well centered. These include the absence of any posterior capsule folds, no distortion of the capsular bag, and an equal distance from the capsulorhexis and pupillar edge. During the removal of viscoelastic, the lens will turn properly if well positioned.
I believe it is possible to achieve an objective accommodation measurement of the 1CU by asking patients to read for both far and near distance, keeping in mind that there is an optical relationship between diopters and reading distance. In addition, new computerized systems are under development to achieve better clinical measurements.
Vittorio Picardo, MD, heads the Ophthalmic Department at the Casa di Cura Nuova Itor in Rome, Italy. Dr. Picardo may be reached at +39 6 854 7845; eyeboss@vpicardo.it
