The Quest for True Accommodation

The technology needed to build a true accommodative intraocular lens (IOL) is not yet ready, but there is reason to remain optimistic about seeing them in the not too distant future, according to Mayank Nanavaty MBBS, PhD.

“Traditional IOLs only give pseudoaccommodation, and multifocal and EDOF lenses have their trade-offs with dysphotopsia. There is an unmet need to correct accommodation in pseudophakic eyes,” he emphasised.

Injectable accommodative IOLs have been in development for at least a decade. The common mechanisms companies use to improve accommodation in these kinds of lenses include capsular bag expansion, anterior optic displacements, anterior surface curvature changes, and gradient refractive index modulation.

Over the years, many models and designs have been developed and remain under investigation, but as Professor Nanavaty explained, the literature is scant for most of them.

Of the accommodating IOL platforms in development, each takes a distinct approach.

The FluidVision IOL (Alcon) is a dual-optic, fluid-filled system in which ciliary body contraction reshapes the optics to deliver up to 5.0 D of accommodation through a standard phaco incision. It currently shows the highest clinically demonstrated accommodative amplitude among existing platforms.

The JelliSee IOL (JelliSee Ophthalmics Inc.) uses a biomimetic gel replicating the paediatric crystalline lens, demonstrating good rotational stability in human trials, with a bilateral study initiated in Q1 2025. The Juvene IOL (LensGen) has two plates, with the anterior element shifting forward for near and intermediate vision, and its 36-month data represents the strongest long-term evidence among injectable platforms, despite not yet being commercially available.

The OmniVu IOL (Atia Vision) offers continuously variable power via a fluid-based element driven by ciliary contraction and is currently in human trials. Finally, the Lumina IOL (AkkoLens International) relies on two sliding plates that move with muscle contraction, achieving up to 2.5 D in phase 3 trials, while sulcus fixation entirely avoids capsular bag complications. The cumulative amplitude of these technologies ranges from 1.5 D to 5.0 D, Prof Nanavaty reported.

Reported clinical outcomes include an uncorrected visual acuity of 20/25 or better in most patients, intermediate acuity of 20/32 or better at 60–80 cm, and near acuity of 20/40 or better in 70–85% of cases without distance compromise. Spectacle independence ranges from 85% to 92%, although this falls short of existing simultaneous vision lenses. Dysphotopsia rates have been reported as low.

However, Prof Nanavaty said the major challenge is posterior capsule opacification (PCO), when lens epithelial cells migrate and compromise the optics and accommodation over time, followed by capsular fibrosis and bag contraction.

Material science requirements include biocompatibility, long-term stability, optical clarity, viscoelasticity, and molecular weight. Other challenges include the unproven role of capsulorhexis and the shrink-wrap effect in PCO prevention, neuromuscular adaptation, and the difficulty of delivering complex devices through small incisions without deforming the capsular bag. Each model also requires tailored surgical techniques, and none have yet proven compatible with the available phacoemulsification technology.

Prof Nanavaty anticipates a future with the development of smart polymers, microincision delivery systems, modular upgrade platforms for accommodative lenses, and the integration of new IOL power calculations.

“Collaboration across material science, bioengineering, physiology, and clinical surgery is essential for successful future clinical translation,” he concluded.

Prof Nanavaty spoke at the 2026 ESCRS Winter Meeting in Helsinki.

Mayank Nanavaty MBBS, DO, FRCOphth, PhD is Consultant Ophthalmologist and surgeon at the University Hospitals Sussex NHS Foundation Trust, UK. mayank.nanavaty@nhs.net