Current IOL technology

[Uilleann]

For any of the docs here - I seem to remember reading about a trial IOL product (maybe 10 years or so back), that was designed to mimic the natural crystalline lens structure of the eye far better than the current generation of hard plastic lenses. Even the multi-focal designs (that I'm aware of anyway) offer a limited, at best, amount of accommodation.

The lens as I remember it, was a soft material, like a gelatin or silicone perhaps? It was ordered in the required power of the pt based on the usual A's and K's commonly used now. The lenses were shipped to the surgeon in a 1mm clear rod form, and as the article described, the material would react to the body temperature of the pt as it was inserted into the capsule. As it was inserted, the lens was said to deform from the rod, and take on the form of the natural crystalline lens. The process would take an average of 30-60 seconds, as the surgeon slowly worked the rod into the eye, and the lens fully expanded into it's final shape.

The real kicker of this lens was that it remained soft, and was hoped to be able to return much of the natural accommodative ability of the eye. At the time of the piece, I can't remember if it was being tested in human trials, and perhaps it wasn't even that far yet. Just wondered if any of the good docs here remember hearing of this product, and might know if it ever made it through trials or has been used in Europe or Asia perhaps, if not in the USA?

Hope I'm not being too vague in the above description. Sadly, I can't remember the name of the product or the company that produced it. If I had to pin a time frame, I would guess 2001-2002 or so? Anyway, thought I'd throw it out there.

Cheers!

[Barry Santini]

Not sure it world work. By the time most seniors have implant surgery, the zonules, the capsule and related structures have aged as well, and probably would not allow the springback of the lens completely.

My speculation.

B

[Uilleann]

I don't think the claim was full accommodation as I remember it Barry, but it seemed it might be a fair bit better than the current generation of multi-focal IOLs could offer. In addition to the flexibility, I believe it was more or less a full capsule sized replacement, so the glare and artifacts many IOL recipients have now with light at the edge of the implant would be largely or completely negated. Again, this is all from my rather foggy memory - but that article was pretty amazing in concept to me. Hence why I was curious if now anything like that was used or if anyone was even aware of it today?

[Barry Santini]

BTW Uilleann, I spent Saturday nite on the Intrepid observing with Al Nagler. Their new Hubble @ 25 exhibit opened, and we saw the Space Shuttle.

Also Andromeda through the new 127 with modified focuser back. Just a smudge really, in the middle of NYC.

B

[Uilleann]

Sweet beans Barry! :)

I did some further searching last night, and can't seem to find any info on the IOL technology I had seen. I was hoping I'd at least find the name of the company, if not the lens itself.

[drk]

Maybe you're crazy and have conflated a few things.

Medennium corporation did have a "Smart Plug" that comes in small rod form but it's an intracanalicular punctal plug that "fattens up" at body temperature and is inserted the way you describe. But it's for dry eye, not cataracts.

The only "mobile" lens I know of is Crystalens which has "flexible haptics" and restores a modicum of accommodation.

I can't imagine a form-shaping IOL being able to deliver the precision needed. Can you imagine the pickiness of implanting a +14.0 D lens? Wow.

[Uilleann]

It was definitely an IOL implant Doc. That's what stuck with me about the tech - it seemed to promise a pretty marked jump forward in that line of tech. I do know I read about it in one of the Ophthalmologic surgical trade mags, but can't recall which now sadly. Nothing to do with punctal occlusion at all. At least, not that particular article.

[drk]

I got nuthin'

[braheem24]

http://www.escrs.org/Publications/Eu...rmoplastic.pdf

[revein]

http://www.escrs.org/Publications/Eu...rmoplastic.pdf

Interesting, thanks!

[Uilleann]

Braheem, I think this is the golden needle in the haystack! Where did you find it if I may ask? And do you have a publication date? Memory tells me this was 10+ years back now...

Cheers!

[braheem24]

It's actual name is "Medennium SmartLens" Based out of Irvine CA

Article from 2002

http://www.eyeworld.org/article.php?sid=1103&




You may find this even more interesting



IRVINE, Calif.--(BUSINESS WIRE)--March 31, 2003

Medennium Inc. of Irvine, today announced that it has signed an agreement with CIBA Vision, the Eye Care affiliate of Swiss-based Novartis, in which CIBA has agreed to purchase Medennium's Phakic Refractive Lens (PRL(TM)) product.

http://www.thefreelibrary.com/Medennium+Announces+Sale+of+PRL+to+CIBA+Vision.-a099620400

[erichwmack]

Yeah it was called the SmartIOL by Medennium. Or it was when I wrote a paper about the concept you are asking about. The ultimate solution to a biomimetic IOL is called pahco-Ersatz. It is a very interesting concept and I feel achievable. I attempted to outline my solution as a concept and almost got it published in a national read optometry/ophthalmology magazine until they found out I wasn't a doctor. Then they cut off communication with me. I never tried to hide the fact I was an optician but they also never asked until publication time, oh well. I see their point I suppose. Anyway, I will put a link to the two versions of my paper. The first is the full length paper discussing different types of IOL tech and their shortcomings. The second is a link to the magazine edition.

It is a string interest of mine so if anyone has questions I will be glad to try and answer. If anyone has a magazine and wants to publish it let me know ;)

http://www.erichwmack.com/materials/Phaco-Ersatz1.pdf
http://www.erichwmack.com/materials/...%20IOL%27s.pdf

[erichwmack]

Here is the SmartIOL excerpt from the paper:

Another Phaco-Ersatz type IOL which is under development is the SmartIOL by Medennium. This
lens overcomes many of the challenges that other polymer filling techniques face. Specifically,
calculating how much polymer to inject, controlling the refractive power, and removal of the cataract
through micro-capsulorhexis. The SmartIOL is made of a thermoplastic with very specific controlled
dimensions. Prior to implantation it is formed into a thin rod. After implantation the rod returns to its
original shape due to exposure to body temperatures. This IOL completely fills the capsular bag which
reduces capsular fibrosis, allows for easy IOL centration, and reduces edge glare. However, the
SmartIOL is a uniform gradient refractive index, so to produce useful refractive correction and
accommodation the lens must be of a high refractive index or a steeper than natural surface curvature.
"Another Phaco-Ersatz type IOL which is under development is the SmartIOL by Medennium. This
lens overcomes many of the challenges that other polymer filling techniques face. Specifically,
calculating how much polymer to inject, controlling the refractive power, and removal of the cataract
through micro-capsulorhexis. The SmartIOL is made of a thermoplastic with very specific controlled
dimensions. Prior to implantation it is formed into a thin rod. After implantation the rod returns to its
original shape due to exposure to body temperatures. This IOL completely fills the capsular bag which
reduces capsular fibrosis, allows for easy IOL centration, and reduces edge glare. However, the
SmartIOL is a uniform gradient refractive index, so to produce useful refractive correction and
accommodation the lens must be of a high refractive index or a steeper than natural surface curvature.
Both of these modifications can make HOA more of an issue. [1,2]"