Despite multiple advances in IOLs and the tools we use to implant them, the basic design of IOLs has remained essentially unchanged for 50 years: an optic with two or more haptics affixed. Enter the Harmoni Modular IOL (ClarVista Medical). With this two-component design, the haptics—the base of the lens—can serve as a stable platform in the capsular bag, and the optic component can be exchanged or adjusted to accommodate each patient’s changing visual needs.
AT A GLANCE
• The two-component Harmoni Modular IOL allows surgeons to address the changing needs of patients over time.
• With the base simulating a capsular tension ring and holding the capsular bag securely, the optic can be safely decoupled and removed, and a new optic can be inserted.
I have implanted about 100 Harmoni IOLs over the past year, including monofocal and monofocal toric models. A big advantage of the lens’ design is that all patients can benefit from the enhanced stability of the Harmoni haptic system and the resulting predictable lens position. Because the base component rests securely along the equator of the bag, effective lens position remains stable, making computation of the optic power to be used more accurate. Predictability is high for both primary implantation and optic exchange cases because of the stability of the base.
The Lens: Harmoni Modular IOL
CLARVISTA MEDICAL
• Composed of two components: the base, or haptics, and the optic
-Base component secures the lens in the capsular bag and captures the optic component
-Optic component provides flexibility to adjust or exchange the optic at any time
• Both components made of hydrophobic acrylic material
• Both implantable through clear corneal microincision
• Base receives optic component using traditional surgical tools
• Optic can be exchanged to optimize short- and long-term refractive needs and rotated to optimize astigmatism correction
• Design has the flexibility to customize vision with monofocal, toric, multifocal, or enhanced depth of focus optics
• Currently available with a full complement of monofocal optics (10.00–30.00 D in 0.50 D increments) and toric options of 1.50, 2.25, and 3.00 D at the corneal plane (T3,T4, T5); according to the company, a multifocal portfolio will be available in 2017 and an extended depth of focus lens shortly thereafter
Courtesy of ClarVista Medical
For more information: www.clarvistamedical.com/harmoni.htm
An additional advantage of the lens design is the exchangeability of the Harmoni’s optic component. No other lens system offers me the confidence and flexibility to address patient dissatisfaction or to incorporate future improvements in optic design. With the base simulating a capsular tension ring and holding the capsular bag securely, the optic can be safely decoupled and removed, and a new optic can be inserted without fear of damaging the capsular bag, no matter how long after primary implantation surgery. This is unlike other IOLs, with which there is a high risk of capsular rupture during lens exchange due to strong adherence of the haptics to the capsular bag.
POINTERS AND TIPS
The nice thing about the Harmoni Modular IOL is that there are really no tradeoffs. I think this lens can be the perfect choice for all cataract patients, but, in particular, it may be helpful in those with a low degree of corneal cylinder. For example, even though an eye with 1.00 D of corneal astigmatism could likely benefit from a toric lens, not all surgeons would counsel the patient in that direction. Furthermore, I believe it is important to inform patients that the surgical incision itself may or may not increase the eye’s cylinder and affect visual outcome. Now, with the Harmoni lens system, surgeons can be conservative and place a monofocal nontoric lens and observe the outcome. The patient knows that, if he or she is not fully satisfied, an optic exchange will be easy to perform, and a toric lens can replace the current optic safely and easily.
As with any new lens modality, there are some key tips that can help surgeons have a smoother learning curve. For the Harmoni Modular IOL, my top two are as follows:
Tip No. 1: Be sure to maximize pupil dilation. I have implanted the Harmoni system in patients with small pupils, but it is easier, in my opinion, when the pupil diameter is 6.5 mm or larger.
Tip No. 2: Make the capsulotomy slightly larger than normal. I have found it helpful to make the capsulotomy about 5.7 to 6 mm. The capsular opening must be larger than for other lenses in order to accommodate implanting the base and exchanging the optic later if needed.
CONCLUSION
The standard IOL design is no longer capable of meeting the demands of many of today’s active seniors, who may well have decades of life ahead of them when they undergo cataract surgery in their 60s. The modular design of the Harmoni IOL allows us to address the changing needs of our patients over time.
With this lens, surgeons can have peace of mind that they have given their patients multiple options for the future.
