Cataract & Refractive (page 7)

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The pressure is on for the lenses of tomorrow
Overall it seems clear that IOL advancements will shape the future of cataract and perhaps refractive surgery in the next few years. Surgical techniques are becoming more refined, less invasive and simpler, now the search goes on to find the lenses that can complement the package.

"My advice to industry would be to work to restore accommodation, not multifocality, and to continue to improve microincision techniques and devices. I expect, in the next five or ten years, that we will be restoring accommodation through microincisions," predicted Dr Alió.

Dr Alió recommends that we look out for the NuLens (NuLens Ltd.) accommodating IOL, which is currently undergoing investigation. He is also following progress with the new Crystalens, in the hope that some of the problems with the previous model have now been addressed. In the shorter term, Professor Dick suggests that we keep an eye on the Light Adjustable Lens (LAL; Calhoun Vision), which is also under investigation. This lens allows the surgeon to adjust the IOL power once the eye has healed, the aim being to customize power predictably to achieve optimal vision after cataract surgery without the need for glasses.

"If I had to invest in something
today, I would invest in
accommodation through microincisions…
This will completely replace all
technologies and lenses that we
use today"

Dr Alió also feels that diagnostic equipment will continue to improve in 2008. "We will be making objective assessments based on light scattering and on the intraocular performance of the natural lens and IOLs," predicts Dr Alió. According to Dr Alió, this improved instrumentation will be made more readily available moving into 2008, which will allow surgeons to make more accurate assessments and judgements. "Simply speaking, I can foresee an instrument that indicates to us which IOL to implant. These instruments will pay for themselves because the decisions that we make will be based on a much more solid base," he added.

Dr Faschinger hopes to implant a lens that is coated in antibiotic in the future, he would also like to see the development of technology that continuously monitors IOP whilst an IOL is in situ. "Most of all, I would like to see more effort being made to help underprivileged people and a reduction in the number of people being blinded by cataract in developing countries, moving us closer to Vision 2020," he said.

"At the beginning of the 90s, when we began working with an erbium-laser for cataract surgery, someone ask me what the dream was of a young anterior chamber surgeon for the end of the century. I told them that the dream was to one day perform cataract extraction through a very small incision and then to refill the capsular bag with an injectable lens in order to preserve accommodation. Well today, almost 20 years on, I think that the first part of this dream has been reached and the second part is on the horizon," reflected Dr Franchini. "The information that we have seen from companies leaves us hoping that the second part of my dream is not too far off, if not in 2008, then shortly afterwards," he added.

Within the area of refractive surgery, Dr Vergés believes that new femtosecond laser technology and accompanying lamellar procedures will see corneal transplantation become a refractive surgery procedure. "Corneal inlays and new laser profiles will also mark the next step in our search for a presbyopia solution," he predicted.

"'If I had to invest in something today, I would invest in accommodation through microincisions, particularly in the field of cataract surgery. This will completely replace all technologies and lenses that we use today," concluded Dr Alió.

References
1. O. Findl & C. Leydolt. J. Cataract Refract. Surg. March 2007;33(3):522-527.
2. J.L. Alio, J.L. Rodriguez-Prats, A. Galal. MICS (Microincision Cataract Surgery). Highlights of Ophthalmology International, Miami, USA 2004.
3. R. Menapace. J. Cataract Refract. Surg. June 2006;32(6):929-943.
4. M. Elling. Objective measurement of accommodation using a dynamic stimulation aberrometer. ASCRS 2007, April 27-May 2, San Diego, US.
5. A. Agarwal, et al. Ophthalmology Times Europe July/August 2007; 3(6):24-28.
6. M.C. Knorz. Ophthalmology Times Europe October 2007;3(8):34-36.

Special contributors

         Jorge L. Alio, MD, PhD                H. Burkhard Dick, MD

        Christoph Faschinger, MD              Alessandro Franchini, MD

        Pavel Kuchynka, MD                      Carlos Verges, MD, PhD

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