Q&A: J. Stuart Cumming reflects on past, current IOL development
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Cataract surgery has undergone many developments since J. Stuart Cumming, MD, FACS, FRCOphth, began his career, yet he continues to be a leading voice in IOL development.
Cumming, the developer of the Crystalens (now owned by Bausch + Lomb) and founder of Cumming Ophthalmic Research and Development (CORD), remembered that the ciliary muscle still functioned in older patients. This led to his decades-long mission to create an accommodating IOL.
Healio/OSN spoke with Cumming about his years of experience, including his journey from an OB/GYN specialist to one of ophthalmology’s leading inventors and surgeons, as well as his newest device, the model SC9 IOL.
Healio/OSN: How did your career as an ophthalmologist begin?
Cumming: I am originally from England. I was in the Australian Navy for a while, and after 4 years in Australia, I went up to Portland, Oregon, and that is when I became involved in ophthalmology. Before that, I was an OB/GYN. But in those days, as a foreign graduate, I could not practice medicine until I was a U.S. citizen, and that took 5 years. So, 6 years out of medical school, I finished up as a lowest-level rotating intern, where the salary was very little. I was paid $10 to supervise school football games. A very useful amount in those days.
During this time, I could choose 1 month where I could do something other than medicine, surgery or pediatrics. The senior resident in ophthalmology recommended I spend a month in his department. And in that month, I decided the last thing I wanted to be was an OB. I completed the residency and passed the boards in Oregon and California, but I was 1 year short to become a U.S. citizen. I was very lucky to get a job in a small company in those days, Allergan. It was exciting to be in a rapidly growing company and a new experience for me. During this time, I hired Jim Largent who eventually headed the surgical division and spent a lot of time in Washington, D.C., representing the company. I was with the company for 4 years as the medical director and later the vice president of the international division.
Healio/OSN: When did you begin working with the first foldable lens?
Cumming: After the 4 years at Allergan and with citizenship and licensed, I joined Anaheim Eye Medical Group. There were five of us in the group. That is where I got involved with the first foldable lenses from STARR Surgical. I think I was maybe the third person ever to implant a foldable plate lens. I implanted other lenses, but that was my favorite lens because I noticed when I implanted it that it was located posteriorly in the capsular bag, and many patients had excellent uncorrected vision.
Healio/OSN: Is this when you became involved in the development of the Crystalens?
Cumming: I noticed that some of these patients could see and read very well and had good distance vision without dysphotopsias.
So, I scanned the location of the lens optic along the axial length of the eye with and without chemical stimulation and showed that it was moving forward, accommodating. Then I measured the location of the optic along the axis of the eye in plate-haptic lenses and those with long loops and found that the spread along that axis of the eye was 2 mm with long loop lenses and just 1 mm with plate-haptic lenses, so they had a more consistent axial location and better visions. I published this, and that gave me the first idea that we could make an accommodating lens.
My friend Tien Nguyen, who was an engineer as well as a helicopter pilot in the South Vietnam forces, made the molds and lenses for me. I took the first lenses he made, put them in my pocket and took them over to England where the first few lenses were implanted.
I had another friend, Jochen Kammann, MD, in Dortmund, Germany, who was highly respected in Germany and had a large practice. I talked to him at a meeting about my idea for a new accommodating lens and said that I needed somebody to implant several iterations of the new lens. He agreed to help. So, I took the lenses over to the Netherlands so they could be packaged, sterilized and certified. Then I drove them down to Dortmund, and I watched Jochen implant them.
We went through six designs over a 5-year period. It takes a long time to go from one design to the next. The problem was that during accommodation, the lenses kept moving out of the bag and slipping forward, dislocating into the sulcus. So, I embedded a T-shaped polyimide distal addition to the plate haptic. It did not move, and the visions were still good. With the sixth and final design, I co-founded what became Eyeonics. The FDA approval of the Crystalens changed ophthalmology. With Jim Largent’s help by representing Eyeonics in Washington along with help from Chris Cox, our local representative, the premium channel was born.
We received FDA approval and got the accommodating lens claim. And so, how is it working? Nobody ever explored that until now.
The pressure goes up in the back and down in the front when you accommodate, and that is the method of creating an accommodating lens.
I have had the Crystalens in both my eyes for more than 20 years, and I have hardly ever put glasses on since they were implanted. But to this day, there is not a true accommodating lens. However, there is another method that I have discovered in the new lens that we are developing.
Healio/OSN: Can you talk a bit about the model SC9 lens?
Cumming: A spherical lens has a depth of focus called spherical aberration; when the light passes through the lens optic, the light from the periphery of the optic focuses closer to the optic than the light going through the middle. I think most people in ophthalmology have forgotten that a spherical lens provides a depth of focus. When I realized this, I thought about having a single focus optic that can provide vision at all distances without multifocality and of designing a lens that can put that depth of focus onto the retina, so that is what we set out to do.
We are comparing one silicone lens with another, both lenses being spherical. One lens optic can provide better vision than the other one even though they are identical, and it is thought to be because of the lens location along the axis of the eye.
The SC9 has a rigid fixed-length haptic/paddle structure that is 10.5 mm long and is almost surrounding the optic. It is attached to the optic with a four-point symmetrical torsional bar structure, being longitudinally foldable. This plate haptic structure is designed to give the optic a consistent axial location. The LI61SE haptic is a 13-mm long C-loop structure with two highly flexible haptics attached to diametrically opposing edges of the optic. Once implanted, the LI61SE’s optic must then have a variable axial location in the 4- to 5-mm void following the extraction of the crystalline lens. We are comparing two lenses, both with biconvex spherical silicone optics. The difference in the two designs is in the haptics structure. The SC9 lens has longitudinal rigid fixed-length plate haptics attached to the optics by four torsion bars.
Juan Batlle, MD, a friend in Santo Domingo, Dominican Republic, and an excellent surgeon trained at Duke and Bascom Palmer, helped us develop the lens. I took off from my practice and used my salary to develop the lens. Now I am spending the money from when we sold the Crystalens to Bausch + Lomb on developing this lens. I think the average ophthalmologist is going to be surprised when they learn that there is a monocular 2 D of depth of focus at 20/32 vision and more than 2.6 D binocularly. At 20/40, this is monocularly 2.74 D and 3.3 D binocularly measured from maximum plus to maximum minus in a standard spherical single-focus lens without the unwanted visual symptoms sometimes seen in multifocal and extended depth of focus lenses.
Our team is excited about this new development.
References:
- CORD, LLC completes one-year follow-up on subjects from the model SC9 intraocular lens FDA clinical trial. https://www.prnewswire.com/news-releases/cord-llc-completes-one-year-follow-up-on-subjects-from-the-model-sc9-intraocular-lens-fda-clinical-trial-301422273.html. Published Nov. 11, 2021. Accessed Aug. 10, 2022.
- More than 2,000 CrystaLens IOLs implanted worldwide. https://www.healio.com/news/ophthalmology/20120331/more-than-2000-crystalens-iols-implanted-worldwide. Published Aug. 15, 2002. Accessed Aug. 10, 2022
For more information:
J. Stuart Cumming, MD, FACS, FRCOphth, can be reached at email: jscumming@gmail.com.
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