Refractive use for IOLs will gain popularity in future, panel suggests

ANAHEIM, Calif. — A renowned group of surgeons predicted the future of treatments for refractive errors will borrow technology from the cataract subspecialty. Furthermore, the IOLs designed specifically for cataract surgery will continue to improve contrast sensitivity and, therefore, true visual acuity as well, they added.

During a press briefing here at the American Academy of Ophthalmology, Jack Holladay, MD, MSEE, FACS, called Pfizer Ophthalmics’ Tecnis modified prolate IOL “the biggest improvement in IOLs I’ve ever seen.” He said in his opinion, within 3 years, every IOL on the market will have technology incorporated into it that will help improve patients’ contrast sensitivity.

Roger Steinert, MD, said he believes multifocal IOLs will gain in popularity as well, as they will increasingly become the lens of choice for implantation in hyperopes and younger cataract patients. “They offer simultaneous vision. We believe the visual cortex adjusts after lens implantation. Younger patients can better tolerate them,” he said.

“There also has been a new resurgence of interest in this technology, both with Alcon in the United States and Pfizer in Europe [investigating new multifocal IOL designs],” he said.

Richard L. Lindstrom, MD, said he is a proponent of accommodating IOLs for cataract surgery, because “what patients want is true accommodation,” he said. The lenses work under patient control, where there is no loss of contrast sensitivity and no loss of stereopsis. Patients have a full range of focus from near to far, he said. The CrystaLens (eyeonics) received U.S. regulatory approval late last week; Bausch & Lomb, Advanced Medical Optics (AMO), HumanOptics, Visiogen and Quest are among those manufacturers whose accommodating IOLs are progressing through the trial stages.

The downside to the lenses, Dr. Lindstrom said, is that “they are the first technology that’s really good that won’t be available to Medicare patients.” He explained that if a patient is diagnosed with cataract as the primary disease, and is willing to pay out of pocket for the lens, then Medicare will approve it. If the patient is on Medicare, but does not have cataract as a primary diagnosis, “it’s illegal for me to implant this lens … I have to tell them I can’t do the procedure and they can’t have it. It’s a difficult issue.”

Dr. Lindstrom said he believes the Verisyse (AMO) lens will receive U.S. approval early next year.

I. Howard Fine, MD, said he minces no words about the future of refractive surgery. “Refractive lens exchange will be the dominant refractive procedure of choice. It uses surgical techniques all anterior segment surgeons are familiar with. It will create the biggest triple win in the history of medicine.” Dr. Fine suggested that the Tecnis multifocal lens will begin trials “shortly.”

As for cataract, “bimanual phaco is here to stay, make no mistake about it,” he said.

Outside the realm of IOLs, Samuel Masket, MD, introduced the concept of implantable devices for eyes with iris defects. Although these devices have been approved for use in Europe, Dr. Masket said he is implanting them in the United States under a Food and Drug Administration Compassionate Device Exemption.

Douglas Koch, MD, suggested wavefront technology and telescopic IOLs have a potential for patients with advanced stages of age-related macular degeneration. A phase-1 study included 15 eyes in the United States. Patient results indicated central vision improved in most patients and a 2-line improvement in best corrected visual acuity for 77%, with 62% of patients seeing a 3-line improvement in BCVA. Phase 2 trials are ongoing, he said.