BLOG: The IOL that forgives
Recently I had the opportunity to perform the first worldwide implants of the AccuraSee intraocular pseudophakic contact lens to improve near vision in patients with macular degeneration.
This is a fascinating invention from Kevin J. Cady, an eye care industry veteran who devised a small implant that rests on top of and couples with an existing posterior chamber IOL, altering its focus. The concept is loaded with promise.
The AccuraSee intraocular pseudophakic contact lens (IOPCL, OnPoint Vision) is part of a first-in-human investigational device exemption study. It is a spherical +11 D lens designed to improve near vision in pseudophakic patients with advanced dry age-related macular degeneration who have undergone prior cataract surgery. At this power, we would expect improvement similar to a +7 D lens at spectacle plane, making it a permanent, uniocular low vision aid.
The lens is implanted via an injector through a small corneal incision following a small amount of viscodissection of the anterior capsule from the preexisting IOL and from its posterior capsule attachments. In the two cases I performed, this was straightforward, despite the original IOL surgery being 10+ years ago and the posterior capsules being opened previously by a YAG laser. Ralph Chu along with two other U.S. surgeons have made similar observations during the first U.S. implants performed with a lower diopter power designed to correct residual refractive error in low vision long-standing pseudophakic patients. In other words, this is an implant that should be doable by any surgeon reasonably comfortable with anterior segment surgery.
The IOPCL’s possible uses, though, are what make it exciting because they go well beyond dry AMD. Future iterations of this IOL could incorporate lower power sphere cylinder to correct residual refractive error — a sort of poor man’s adjustable IOL. Other designs could address higher-order aberrations or perhaps unwanted visual side effects from multifocal lenses as well as a multifocal platform that is fully reversible.
Best of all, early evaluation of the patients shows no measurable loss of best corrected distance visual acuity and a significant improvement in near, as is common when a high add is placed in these patients. Seeing detail at both intermediate and near seems to be meaningfully improved, with a doubling of near visual acuity seen in both of my patients.
Even after successful IOL surgery, comorbidities can rob many of our patients of the vision they deserve. We may now have a technology that can at least partially forgive the sins of long life and bad luck.
Collapse