Accommodative IOLs, scleral bands will become commonplace in future, panel says

ANAHEIM, Calif. — Both scleral expansion bands and accommodative IOLs will become standard choices for the treatment of presbyopia in the next 5 years, according to a panel discussion held here at the ISRS/AAO refractive surgery subspecialty day meeting. Most audience members agreed.

Panelists including Perry Binder, MD, Robert Maloney, MD, James C. Hays, MD, Robert Kershner, MD, John T. LiVecchi, MD, and Ronald Schachar, MD, PhD discussed the pros and cons of the available surgical treatments for presbyopia.

“One thing we need to address is functional uncorrected distance and near vision,” Richard L. Lindstrom, MD, told the attendees. “What is functional? 20/40 and J3 is a reasonable definition.”

“Scleral expansion does not, cannot and will not restore the accommodative capacity to the crystalline lens,” said Adrian Glasser, PhD, during his presentation. When questioned by the panel, about 70% of the audience agreed with Dr. Glasser’s conclusions.

“One thing we need to remember,” said Dr. Binder, “is that scleral expansion bands work well in practice but not in theory.”

Conductive keratoplasty (CK) is another treatment showing promise for correcting presbyopia, noted Francis Price, Jr., MD, but the procedure is currently not approved for that indication in the United States. Dr. Price described an off-label use trial he conducted of CK for presbyopia in 143 myopes in the range of –1 D to –1.5 D. At 6 months postoperative, 85% had binocular uncorrected visual acuity of 20/25 or better distance vision, along with J3 or better near vision, compared with 9% preoperatively, he said.