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Laser technology builds refractive power into IOL

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SAN DIEGO — Incoming ASCRS president Nick Mamalis, MD, believes he knows what the next disruptive IOL technology will be: refractive indexing.

In a presentation at Refractive Subspecialty Day at the American Society of Cataract and Refractive Surgery meeting, Mamalis said, “When you use what’s called refractive indexing, you can simultaneously build refractive change into an IOL itself.”

The laser-induced refractive index change technology is being tested for its ability to make refractive adjustments in corneas and contact lenses, as well as in IOLs.

Mamalis’ research is focused on making IOL power changes with the laser, in which the laser is docked much like a femtosecond laser and then creates a phase-wrapped structure in the polymer of the IOL.

“This is not on the surface of the eye, it’s subsurface, so the IOL surface is still smooth,” Mamalis said.

In in-vitro laboratory tests with the treatment, Mamalis and colleagues at Moran Eye Center found no significant increase in light scattering, no real effect on the MTF function and minimal effect on light transmittance. Potential for the technology includes adding multifocality to an IOL as well as canceling a multifocal pattern and making it monofocal.

“This works wonderfully in the laboratory but what about in the living eye,” he asked.

In in-vivo tests in rabbit eyes, no toxicity or inflammation was seen after treatment.

“More importantly, when we removed these IOLs and looked at the power change, we found it was incredibly precise. We were within about one-tenth of a diopter in intended treatment,” Mamalis said.

The potential for power adjustment with the femtosecond laser includes use in both hydrophobic and hydrophilic acrylic IOLs, Mamalis said. Furthermore, it is noninvasive, fast and only requires topical anesthesia; multiple adjustments can be made; premium functions can be added and removed, and there is no need for special protective spectacles after treatment.

“Refractive indexing, is this the next best thing? Absolutely,” Mamalis said. – by Patricia Nale, ELS

Reference: Mamalis N. Refractive indexing: is this the next big thing? Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 3-7, 2019; San Diego.

Disclosure: Mamalis reports he is on the scientific advisory board for PowerVision.