TREATMENTS FOR PRESBYOPIA HAVE EVOLVED SIGNIFICANTLY, from over-the-counter reading glasses, to multifocal or monovision contact lenses, to monovision laser vision correction, to modern day premium intraocular lenses (IOLs). With presbyopia-correcting eye drops and their formula manipulations of topical pilocarpine or equivalent on the horizon, and laser scleral microporation in the not-so-distant future as well, the modern presbyope—in many cases—will be able to achieve visual freedom for the rest of their lives.

Over the last few years, we have enhanced our premium IOL armamentarium significantly with FDA approvals of the Vivity non-diffractive EDOF and PanOptix trifocal IOLs (Alcon) and Eyhance monofocal with “benefits” and Synergy combination trifocal-EDOF IOL (Johnson & Johnson). Other companies, such as Carl Zeiss Meditec and Bausch + Lomb, also have trifocal IOLs in clinical research stages.

However, limitations still exist with these current approved technologies, including complaints of glare and halo, reduced contrast sensitivity, positive and negative dysphotopsias, waxy vision, and neuroadaptation failure. The good news is that accommodating IOL technologies are on the horizon that should eliminate and/or address the drawbacks of current presbyopia-correcting IOL options. I will discuss four of these (PowerVision, Atia Vision, Opira, and Juvene), but this is not an exhaustive list.

PowerVision (recently acquired by Alcon)

This is a fluid-based intraocular lens that enables near vision by squeezing a tiny amount of fluid (less than a drop) from the haptics at the periphery of the IOL into the center. When the eye attempts to move to its disaccommodated state, the capsular bag squeezes fluid the opposite way, deflating the lens and enabling distance vision.

Atia Vision (Shifamed)

This modular dual lens design includes a shape-changing accommodating engine and exchangeable front optic. The former is a hydraulic multiplier design, mimicking the natural dynamic accommodation mechanism of the eye. It maintains direct contact with the open capsular bag for efficient energy transfer from the ciliary muscle to the optic. The exchangeable front optic is a fixed lens that addresses each patient’s individual prescription needs. The lens is available in multiple powers and degrees of toricity, and even offers an opportunity for future upgrades as optic technology advances and evolves.

Opira (ForSight Labs)

This sulcus-based, dynamic, shape-changing IOL features direct ciliary body engagement without zonular or capsular bag intermediaries. This IOL is haptic-fixated within the capsulorhexis and has a dynamic anterior surface and static posterior lens available for toric correction and postoperative adjustment.

Juvene (LensGen)

This fluid-filled, modular, dual-design, accommodating IOL is designed to change curvature, mimicking the natural lens. Published data in the Grail Study (IDE)—with data up to one year on 58 implants—demonstrates excellent range of vision, effective lens position, and rotational stability. Study data reflects that 100% of patients achieved 20/25 at distance and intermediate corrected vision (CDVA, DCIVA), and 86% of patients achieved J2 at corrected near vision at 40 cm (DCNVA). In a recent JCRS publication no patients exhibited development of posterior capsular opacification.¹

All of these accommodating IOLs are still in investigational stages and not yet available in the U.S. for implantation. But initial data and designs appear to be promising, with the minimal risk of adverse events we are seeing with our current armamentarium. ■

Reference

1. Bontu S, Werner L, Kennedy S et al. Long-term uveal and capsular biocompatibility of a new fluid-filled, modular accommodating intraocular lens. J Cataract Refract Surg 2021;47:111-117.

Dr. Jackson is Founder and CEO of Jacksoneye, in Lake Villa, IL. He serves on the editorial advisory boards of several publications, is a board member and VP of the American College of Eye Surgeons, a founding member of the American College of Ophthalmic Surgeons, and founding member and past 2018 President of the Cataract External Disease and Refractive Surgery Society.

Disclosures
Dr. Jackson is a consultant for Alcon, Johnson & Johnson, Bausch + Lomb, and Carl Zeiss Meditec.