Laird Harrison

May 04, 2015

SAN DIEGO — New developments in intraocular lenses have led to the expansion of the number of patients who could benefit from them, experts report.

Only 0.2% of Americans with presbyopia have intraocular lenses. That's just 280,000 of the 187.8 million patients who might benefit from the lenses, said Daniel Durrie, MD, from Overland Park, Kansas. "Our system is missing 99.8% of the potential market," he pointed out.

Dr Durrie took part in a seminar on new technology in intraocular lenses here at the American Society of Cataract and Refractive Surgery 2015 Symposium.

To take advantage of the potential market of people 45 to 64 years of age, ophthalmologists should brand themselves as "dysfunctional lens surgeons," capable of treating a spectrum of poor vision that begins with presbyopia and continues into cataracts, Dr Durrie explained.

"I feel that we have this huge wave coming. The market is huge and it's growing, and industry is starting to develop technology," he said.

Multifocal intraocular lenses are an option for patients who want good visual acuity at a full range of distances, said Rex Hamilton, MD, from the University of California at Los Angeles, during the seminar.

Multifocal Lenses

One reason that the multifocal lenses have not caught on yet is that the versions created in the 1990s and early 2000s were disappointing, and sometimes left the patients with halos and poor intermediate vision, Dr Hamilton explained.

Originally, the lenses were not well designed for patients with large pupil sizes, he said, but newer versions of multifocal intraocular lenses have partially addressed this problem.

"The new multifocal lenses are great," he said. "But we still have to set expectations appropriately to avoid disappointment."

Dr Hamilton said he advises surgeons who are implanting multifocal lenses to measure pupil size. "I think it will allow us to appropriately counsel the patient."

Intraocular lenses could provide some presbyopia relief even for patients younger than the cataract age; however, there can be complications and, for some patients, suboptimal quality of vision, said A.J. Kanellopoulos, MD, from the New York University School of Medicine in New York City and the Eye Institute in Athens, Greece.

Presbyopia-correcting lenses are used less often in Europe than in the United States. "One of the main concerns is that if a patient with a multifocal intraocular lens develops retinal disease or glaucoma, the existence of this type of lens will pose a major setback in contrast sensitivity," he told Medscape Medical News.

Phakic Intraocular Lenses

Scott Barnes, US Army chief of ophthalmology and refractive surgery at Fort Bragg, North Carolina, spoke about phakic intraocular lenses.

He reported that his research suggests that these lenses might be more likely than LASIK to correct patients' vision to better than 20/20.

"Seventy-five percent of our patients say this is the best vision they ever had," he said.

Extended depth-of-focus intraocular lenses provide another alternative for the correction of pseudophakic presbyopia, said the seminar's next speaker, Doyle Stulting, MD, from the Stulting Research Center in Atlanta.

"They offer enhanced intermediate and near vision with minimal impact on distance visual performance," Dr Stulting said.

The new intraocular lenses offer many great possibilities for presbyopia, said Herbert Kaufman, MD, from Louisiana State University in New Orleans. And he said he agrees that they have improved in recent years.

But each type of lens comes with potential drawbacks, he explained. The multifocal lenses require the brain to process multiple images at once. "There are a few people who can't stand multifocality and they have to have them taken out," he explained.

Lenses that provide extended depth of focus don't offer clear completely clear images at any depth, he said. And phakic intraocular lenses pose all the risks of cataract surgery in patients who don't have cataracts.

"The trouble is that there is no good way, no infallible way, of trying to decide what the patient is going to like," Dr Kaufman said. And other options are becoming available for presbyopia, he added, such as corneal inlays or eye drops that constrict the pupil to create a pinhole effect.

Dr Durrie reports financial relationships with Abbott Medical Optics, Accelerated Vision Group, AcuFocus, Alcon, Allergan, Alphaeon, Avedro, Strathspey Crown, WaveTec Vision. Dr Hamilton reports financial relationships with Abbott Medical Optics and Alcon Laboratories. Dr Kanellopoulos reports financial relationships with Alcon, Allergan, Avedro, and i-Optics. Dr Barnes reports financial relationships with VISX/AMO and Staar. Dr Stulting reports financial relationships with AcuFocus, Abbott Medical Optics, Alcon, Calhoun Vision, Cambium Medical Technologies, EyeYon, and TearLab. Dr Kaufman holds a patent for eyedrops to treat presbyopia.

American Society of Cataract and Refractive Surgery (ASCRS) 2015 Symposium. Presented April 18, 2015.


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