Welcome to Eurotimes

THE demands on intraocular lens designers today can be expressed in one word: simultaneous. We require simultaneous properties that might not be compatible with current technical possibilities.

We need a lens design that offers simultaneous PCO and ACO prevention, better achievement of near vision either by multifocal or pseudo-accommodative means, and really small incisions (< 2.0mm). We can also foresee a future need for biologically active (anti-infectious, anti-inflammatory) IOLs, and truly accommodating intracapsular devices.

Is long-term preservation of a transparent capsular bag (and not only the posterior capsule in contact with the IOL optic) compatible with a pseudo-accommodating mechanism and a very small incision? Is it possible to satisfy today’s demands simultaneously? If it is not possible, which demand should we consider first to satisfy each patient? What is clinically significant for today’s definitely not “average” patient?

PCO prevention is clinically significant in that it prevents the possible YAG-related iatrogenic complications. ACO prevention is also clinically significant since a transparent anterior capsule is necessary to examine the peripheral retina carefully and to treat retinal tears selectively. A transparent anterior capsule will also prevent capsulophimosis. A non-fibrotic soft capsular bag is a prerequisite for accommodation.

Pseudo-accommodation is clinically significant, as long as it lasts. It is an improvement compared to current multifocal IOLs, and definitely satisfying for the patient. How does the design of accommodating lenses cope with PCO prevention demands? Can we currently simultaneously offer PCO prevention (to avoid YAG complications), a transparent and soft capsular bag, and pseudo-accommodation?

We face the same question with very small incision lenses. They do not claim to improve near vision. How do they keep the capsular bag transparent with a plate haptic design known to be not the best design for PCO prevention? Is the smaller induced astigmatism clinically significant considering these potentially adverse reactions?

Yet all of these developments in IOL design, considered separately, are definite improvements and pave the way for greater patient satisfaction. But we have to consider the simultaneity of improvements as the next step for IOL technology. This is a real challenge for both ophthalmologists and manufacturers. We need new materials, or new combinations of materials, and new designs which do not compromise current standards. Ultimate patient satisfaction is close to an endless effort!

We hope that the discussion opened by EuroTimes will stimulate the creativity of European ophthalmologists and manufacturers.

Philippe Sourdille MD
Founder, Clinique Sourdille, Nantes, France
Email: philippe.sourdille@wanadoo.fr

Top