Until recently, the intraocular lens (IOL) options I could offer a patient with irregular corneas, such as a patient with a history of previous radial keratotomy (RK) or a corneal scar, would have been somewhat limited. I was frustrated that I could not provide these patients with the same type of optimal vision that I could offer other patients.

That situation changed, however, with the introduction of the IC-8 Apthera IOL from Bausch + Lomb. As a cornea surgeon, I am excited to add this lens to my armamentarium.

Developed by AcuFocus, the IC-8 Apthera IOL was approved by the FDA in July 2022 as the first and only small-aperture, nontoric, extended-depth-of-focus (EDOF) IOL for cataract patients who have as much as 1.5 D of corneal astigmatism and wish to address presbyopia at the same time. The IOL is a hydrophobic, acrylic, single-piece lens implant. In January 2023, Bausch + Lomb acquired AcuFocus.

The wavefront-filtering IC-8 Apthera IOL has an optical mask, referred to as the FilterRing component, with a small central aperture built into the lens material itself. The lens has an optic diameter of 6.0 mm and an overall diameter of 12.5 mm. The FilterRing component has an outer diameter of 3.23 mm and an aperture diameter of 1.36 mm. This design allows the majority of the light coming into the eye to enter through the center of the implant.¹

In this article, I will share my experience using the IC-8 Apthera IOL for patients with irregular corneas, which is an off-label use. With this lens, surgeons now have a new tool to help optimize vision in these patients. 

Go-to Lens

The IC-8 Apthera IOL is my go-to lens for patients with previous RK, as well as for select patients with keratoconus and corneal scars. These patients are often not suitable candidates for an EDOF or multifocal IOL due to multifocal corneas and higher-order aberrations, leaving them only the option of a monofocal or perhaps monofocal toric lens. The IC-8 Apthera pinhole optics allow me to optimize patient vision beyond what could be achieved with a monofocal lens.

I have had success using the lens both unilaterally and bilaterally. For instance, for a patient with a complex cornea who had a previous monofocal lens or monofocal toric lens implanted in one eye, I can use the IC-8 Apthera in the other eye.

For these patients with previous corneal pathology, I do not promise that the IC-8 Apthera will address their presbyopia or their extended depth of focus. I do tell them that, overall, their range of vision will improve, certainly beyond what we could achieve with a monofocal lens.

High Satisfaction

Patients typically are highly satisfied. For instance, one of my patients had previous RK bilaterally. Before the IC-8 Apthera became available, I implanted a monofocal toric lens. Unfortunately, even with the best calculations, I had to perform an IOL exchange, which was uneventful.

When I needed to address the second eye, I implanted the IC-8 Apthera with a stellar result: the patient’s uncorrected vision was 20/25 on postop day 1, and he had good midrange vision as well. The result was that his distance to midrange vision was excellent, and he was one of my happiest patients. I have had similar experiences with subsequent patients.

Pearls

When using the IC-8 Apthera lens, I suggest a few surgical pearls for using the lens in patients with previous RK.

1. Perform the biometry/IOL calculation aiming for -1 to -1.25 D.

2. With previous RK patients, you will likely want to make a scleral incision. With the Apthera, you have to enlarge your incision slightly to allow for entry of the lens, so you are not going to go through a typical 2.8-mm incision.

3. If there is enough room, if it is only an 8-cut RK and it did not go all the way to the limbus, or in a patient with corneal scar or keratoconus, it is possible to still make a clear cornea incision.

Giving an Opportunity

Like our other refractive cataract patients, patients with irregular corneas deserve an opportunity to optimize their vision with cataract surgery to allow for the best quality and range of vision that can be achieved, given the limitations of their corneas. I look forward to using the IC-8 Apthera IOL in many more of my suitable patients.

Reference

1. Hovanesian JA. Early Experiences with the IC-8 Apthera IOL. Presbyopia Physician, Vol. 3, June 2023, pp. 28-31.

Disclosures

Dr. Talley Rostov is a consultant for Bausch + Lomb, Zeiss, Johnson & Johnson, and Alcon.

Dr. Talley Rostov is a cornea, cataract, and refractive surgeon and an affiliate surgeon with HCP/Cureblindness.