About 9 years ago, an ophthalmic trade magazine published a poll report in which several prominent ophthalmologists commented on the status of intraocular lens technology. A number of the contributors considered small-incision operations with foldable IOL technology a potential future development for cataract extraction with intraocular implant methods. Yet, some respondents wrote that they felt single-piece PMMA lens technology through a 5.5-mm scleral tunnel was the zenith of cataract/IOL surgery and no further developments were needed. Man, were they ever wrong!
Cataract/IOL technology has reinvented itself many times over since that poll was taken. There have been too many advances to list here, but a few stand out in my mind as exceptional. The first was the progression from the scleral tunnel to the clear corneal incision. Second, the folding technology now employed by the majority of implants has delivered a huge benefit to patients in the form of shortened postoperative recuperation. The concept of cataract surgery's eliminating astigmatism as a postoperative goal gave birth to the “refractive” cataract surgeon. IOL injection systems, from folding forceps to injectors, have bred an entirely new field of discovery, experimentation, and triumph. Finally, phacoemulsification instrumentation in development may, in all likelihood, shrink the size of a main surgical incision to less than 2 mm for the majority of operations (IOLs and injectors for this size incision are already available).
In this edition of Cataract & Refractive Surgery Today, we collaborated with Robert H. Osher, MD, to compile the best demonstrations of the new IOL technologies from his Video Journal of Cataract and Refractive Surgery series. Following is a sampling of the lenses featured.
The Light Adjustable Lens (LAL; Calhoun Vision Inc., Pasadena, CA). Not only could this technology possibly cure the iatrogenic postoperative refractive sins that surgeons experience on occasion, but it very well could be a platform for astigmatic corrections and possibly wavefront-driven corrections in the form of true customized optics.
The AcrySof Single-Piece Toric IOL (Alcon Laboratories, Inc., Fort Worth, TX). This device is now positioned as the first nonplate lens that can treat concurrent astigmatism without the need for corneal refractive surgery.
The AcrySof Natural IOL (Alcon Laboratories, Inc.). The buzz on this lens is its blue light-filtering technology. Is blue light protection necessary in an IOL? Will it lessen the progression or initiation of age-related macular degeneration?The Verisyse Phakic Intraocular Lens (Advanced Medical Optics, Inc., Santa Ana, CA). This IOL recently garnered expedited FDA review.
The Kelman Duet Phakic IOL (Tekia, Inc., Irvine, CA). This implant features a detachable optic and intraocular assembly.
Obviously, IOL technology is nowhere near the end of its development. Read on to learn more about the exciting science behind the latest devices.