The lens most forgiving of all
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The adoption of advanced-technology IOLs, including presbyopia-correcting and toric lenses, in the U.S. still hovers below 20%, a rate that perplexes doctors, the eye care industry and investors.
We know as many as 80% of properly educated patients are interested in what they offer, even with the attendant cost. Many agree that cost is not the limiting factor but rather doctors who hesitate to present advanced IOLs because of fear of an unsatisfactory outcome. The past 5 years have brought new extended depth of focus and multifocal lenses that achieve even more consistent results for a wider variety of patients.
One new lens that particularly signals this shift is the small-aperture IC-8 Apthera lens from AcuFocus, which was recently purchased by Bausch + Lomb. While there is no single advanced-technology IOL that every patient can receive, the IC-8 is one that probably every surgeon should learn to use.
Despite its approval for treating regular astigmatism, much attention has been given to the possibilities the IC-8 brings for irregular eyes: those with irregular astigmatism from off-axis corneal scars, keratoconus and other conditions. For many of these patients, their conditions that make a toric lens a so-so idea make a small-aperture lens a particularly good one, and this is why every surgeon should train on the IC-8.
But the IC-8 may serve its biggest audience among those with low regular astigmatism. In many low astigmats, axis is difficult to determine; topography suggests one axis, optical biometer suggests another, and traditional keratometry yields a third. Which axis do you pick? With small-aperture optics, the axis doesn’t matter, and for lower degrees of astigmatism, the pinhole effect is particularly effective in eliminating distortion.
Alas, no lens is perfect, and the IC-8 does come with a few caveats. With a smaller aperture, some patients do report needing a little more light, which might rule out those with advanced glaucoma or significant maculopathy. Retinal exam can become more challenging with the IOL, but not with a pupil that dilates beyond 5 mm. And YAG capsulotomy should be performed outside the 3.23 mm outer diameter where possible, so study the manufacturer’s “omega” capsulotomy technique to preserve the pristine condition of the mask.
Surgeons around the world have gained confidence from experience with this new small-aperture lens, and we in the U.S. will now add significantly to that base of knowledge. Every week I see patients who are a particularly good fit, and every week I am hearing positive feedback from those who receive it. Indeed, we are lucky to have a specialty in which new technology comes frequently and can thrive. As physicians, we are at our best when we are cautious but willing to learn for the benefit of our patients.
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