Multi-component IOL implantation; a novel concept lens

It is clear that the 21st century will be characterized by the development of new, sophisticated intraocular lenses (IOLs) that can replace the crystalline lens to achieve precise visual acuity at all distances. One of these novel IOL concepts, a surgically adjustable IOL, was discussed for the first time more than 15 years ago, in the 1998 Barraquer Lecture.¹

This adjustable IOL allows fine tuning of the initial refractive result by exchanging one of the optical elements of the lens implant. Surgical adjustments can be performed in the short-term postoperatively to correct residual refractive errors. Additionally, as vision is a dynamic phenomenon, the MC-IOL allows for long-term adjustments for the management of patients refractive changes such as the progressive against-the-rule astigmatism (wound healing, age factors) and capsule contraction. Finally, optical adjustments years after the primary surgery are often desirable, such as in cases where there has been development of age-related macular degeneration (AMD). These adjustments are also easily accomplished with the IVO lens system.

The concept of reversibility of this multi-component IOL is appealing to both patient and surgeon. For example, in cases of failed neuroadaptation or the intolerance of a multifocal lens, patients can request for an exchange for either a monofocal lens or a trial of a monovision lens. Additionally, removing the multifocal optic in case of advancing macular pathology years after primary surgery, to better visualize the macula during retinal surgery can be a very beneficial option for a retina surgeon.

From a surgeon's perspective, having a multi-component IOL is equivalent to providing premium cataract surgery by offering a totally customized prescription at the time of the primary cataract surgery, using a small inventory of lens components, thus theoretically minimizing the need for secondary touchups. Having a manageable inventory of IOLs is not that difficult to achieve with the IVO lens in comparison to all other conventional lenses. Also, the multi-component IOL enables cataract surgeons to introduce new optical technology at any time postoperatively should this become available, as well as handling all refractive issues without the need for expensive additional technology (i.e., LASIK).