As a researcher, I am fascinated by new technology and have focused my interest on presbyopia treatments through participation in studies of corneal inlays; accommodating, multifocal, and extended depth of focus IOLs; and cornea-based procedures. Based upon the success of the small-aperture concept demonstrated by the Kamra corneal inlay (AcuFocus), I was interested in the potential to expand the concept and technology to my cataract patients.
I have tried many presbyopia treatments and have learned that there is always something to gain by presbyopia correction—but not without some sacrifice. The most common complaint of patients, especially those with multifocal IOLs, is photic phenomena, including glare and halos. On the other hand, the most often reported downside of accommodating and extended depth of focus technologies is inadequate near vision. The IC-8 small-aperture IOL (AcuFocus; Figure 1), a one-piece hydrophobic acrylic lens, seems to minimize these shortcomings and provide adequate near vision.
Figure 1. Eye implanted with an IC-8 small aperture IOL.
To date, I have implanted the IC-8 in the nondominant eye in nine patients with cataracts following standard phacoemulsification.1 At 1-year postoperative, mean near UCVA in these patients is J2, and mean intermediate and distance UCVAs are each 20/20.1 I asked patients to compare their pre- and postoperative vision and rate symptoms such as fluctuating vision, distortion, glare, halos, night vision, and overlapping images; all of their responses indicated minimal side effects. I also asked patients to compare these factors with their untreated eye, and all reported similar or better results in the IC-8 eye than in the fellow eye.
A retina specialist and four technicians of varying experience levels assessed the ease of performing visual field, fundus photography, and retinal OCT examinations with the IC-8 in place. All reported that they were able to complete the diagnostic testing successfully with only minor adaptations.
AN EYE TOWARD THE FUTURE
The small-aperture principle seems to work regardless of the presence of corneal irregularity. The IC-8 lens provides an alternative in situations in which I am hesitant to use a multifocal IOL. Having technology with the ability to improve near and intermediate vision without sacrificing distance vision is exciting, and, in time, I expect the indications to grow.
1. Ang R. Visual and optical performance with a small-aperture intraocular lens: first report. Paper presented at: the XXXII Congress of the ESCRS; London; September 13-17, 2014.
Robert Edward Ang, MD
- Senior Refractive Surgeon, Asian Eye Institute, Philippines
- Financial disclosure: Clinical investigator (AcuFocus)