Promising Presbyopia Option

The failure of multiple accommodative IOL designs begs whether achieving a working model is even a possibility. Prompted by the lack of success of previous implants, Jorge L Alió MD, PhD and colleagues set out 14 years ago on a novel path to create an IOL able to restore accommodation.

The product of their research—the Lumina IOL (Akkolens)— is placed in the sulcus, where the only force exerted on it comes from ciliary muscle contraction and relaxation. The action of the ciliary muscle, not the capsular bag, causes the optical elements of the dual-element varifocal lens system to shift across each other in the plane perpendicular to the optical axis, resulting in a change in focal power.

Highlighting published studies, Professor Alió said the Lumina is the only accommodative IOL with highly rated published evidence. Moreover, he proposed this safe and effective accommodating IOL will supplant the use of multifocal IOLs for presbyopia correction.

“Multifocality is not physiological, and multifocal optics will always require some degree of neuroadaptation,” he said. “Once accommodating IOLs are developed adequately, multifocal IOLs will be unable to compete, as happened with pseudophakic glasses and IOLs.”

The Lumina IOL was designed by Akkolens (Netherlands) based on knowledge of the mechanism of accommodation and understanding that the capsular bag becomes non-functional after cataract surgery.

“The capsular bag seems to be the wrong location for accommodating IOLs due to its unavoidable decadence and fibrosis once the crystalline lens is emptied,” he explained.

“Rather, the forces generated at the zonular-anterior capsule system are those for accommodating IOLs. Sulcus implantation is the only option.”

Proof of performance

Results from extensive testing performed in clinical trials comparing the Lumina IOL with monofocal controls provide evidence the sulcus-based accommodative IOL effectively restores visual performance for far distance and provides functional performance for intermediate and near vision, albeit with some interindividual variability.^1,2 Mean decimal uncorrected visual acuity in a series of 44 eyes was 0.90 for distance, 0.89 for intermediate, and 0.85 for near; 98% of patients reported not using reading glasses.

“The near vision outcomes are justified, in part, by the accommodative range, which is variable between 1.0 and 3.0 D with accommodation and pseudoaccommodation. They also correlate well with high patient satisfaction,” Prof Alió said.

He reported that collected data show refractive predictability, contrast sensitivity, and visual quality with the accommodative IOL are comparable to a monofocal lens. Functional, refractive, and accommodative test results also show good stability at follow-up more than three years post-implantation. Bench testing shows image quality with the accommodative IOL is superior to multifocal and extended depth of focus lenses.³

Prof Alió noted that posterior capsule opacification occurs frequently in eyes implanted with the Lumina IOL. Nd:YAG laser capsulotomy is needed in about one-third of eyes by three months after implantation and restores near vision, he said.

“This experience shows not only that outcomes are good after capsulotomy—but it further proves the capsular bag is not necessary for accommodation and the Lumina IOL can be used successfully, even if the posterior capsule breaks,” he observed.

Prof Alió spoke at the 2023 ESCRS Congress in Vienna. 

Jorge L Alió MD, PhD is Medical Director, Vissum Innovation, and Professor and Chairman of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.

jlalio@vissum.com.

1. Alió JL, Simonov AN, Romero D, et al. “Analysis of accommodative performance of a new accommodative intraocular lens,” J Refract Surg., 2018; 34(2): 78–83.

2. Alió JL, Simonov A, Plaza-Puche, et al. “Visual outcomes and accommodative response of the Lumina accommodative intraocular lens,” Am J Ophthalmol., 2016; 164: 37–48.

3. Alió JL, D'Oria F, Toto F, et al. “Retinal image quality with multifocal, EDoF, and accommodative intraocular lenses as studied by pyramidal aberrometry,” Eye Vis (Lond)., 2021; 8(1): 37.