Accurate refractive outcomes are the sine qua non of premium IOL surgery, and despite advances in biometry, they remain somewhat unpredictable.
The Light Adjustable Lens (Calhoun Vision, Inc., Pasadena, CA) is designed to address this problem.
The Tecnis Multifocal IOL is made of an acrylic material with chromatic aberration, which is better than that of the crystalline lens.
This helps optimize the focus of normal white light for distance and near vision.
The next lens most likely to gain FDA approval is the Synchrony dual-optic accommodating IOL (Visiogen Inc., Irvine, CA).
The Synchrony has an anterior optic with a high plus power and a posterior optic with a high negative power (Figure 1).
This accommodating IOL has four broad haptics that fill the capsular bag, which may allow better coupling of the movements of the ciliary body and zonule with the IOL.
The mechanism of accommodation is similar to that of the Crystalens, which moves anteriorly when the zonule relaxes with accommodative effort and thus increases its effective power and reduces myopia (Figure 3).
In a prospective study, presented at the 2009 ASCRS meeting, Ossma and colleagues randomly assigned 100 subjects to receive either a Synchrony IOL or an Acry Sof Restor IOL in both of their eyes.
Distance and near vision was equivalent with the two lenses, but the Synchrony provided significantly better binocular intermediate vision at 60 cm.
A subjective perception of glare and halos at night was more common in the Acry Sof Restor group.
Because of the dual optics, implanting the Synchrony lens is like placing two IOLs simultaneously, which makes it more difficult to insert than standard IOLs.
The next generation of IOLs is bringing us closer to the goals of perfect refractive results and excellent accommodative amplitudes for patients.