New IOLs: tomorrow is already today

Innovative technologies for cataract refractive surgery. The development of new IOLs is in progress and some hi-tech IOLs are already undergoing clinical trials to strike the more and more challenging goals of contemporary cataract surgery.

The development of new IOLs is in progress and some hi-tech IOLs are already undergoing clinical trials to strike the more and more challenging goals of contemporary cataract surgery.
The first important progress has already been achieved by mini-incision IOLs whose tiny size promoted the spread of mini and micro-incision surgical techniques. The main advantages of these techniques are: less induced astigmatism and a higher stability of the anterior chamber, with less complications due to AC failure (see our interview with Roberto Bellucci).
Then we have preloaded IOLs that are going to become a standard in modern cataract surgery. Their advantages are relevant as for the surgical safety (in order to prevent infection risks) and for the correct upload/download of the IOL.
Another important progress has been attained with aspherical IOLs which do not induce or even partially correct ocular aberrations. In fact the new aspherical IOLs provide compensation of cornea positive spherical aberration and a reduction of postoperative PCO (Posterior Opacification of the Capsule – see the article by prof. A. Caporossi).
At present one of the most challenging targets is the simultaneous correction, in the same surgical operation, of cataract and presbyopia.
Presbyopia is a physiological condition which is naturally related to ageing, so the offer of new IOLs  for presbyopia refractive cataract  will surely be of great importance for eye surgeons.
In these last years the most innovative products for presbyopia surgical treatment have been based on multifocality or on the final accommodation attained by cataract surgery.
The target of the best “artificial accommodation” is surely the main barrier to the fast growth of the market share of hi-tech IOLs.
In the last decade the development of IOLs for presbiopia surgery has undergone a deep evolution. We started from refractive and diffractive multifocal IOLs, which however caused many problems related to the lack of vision continuity at different distances and therefore induced annoying postoperative halos.
An alternative to multifocal IOLs were accommodative IOLs, by their clinical performance was not satisfying for  the eye surgeons.
The latest innovation are EDOF IOLs. EDOF stands for per “Extended Depth Of Focus”  and, as stated in FDA (Food and Drug Administration) report, the main characteristics of these IOLs are:

  • Design concept – to increase positive depth of focus to enhance intermediate and near visual performance while having minimal impact on distance performance (continuous vision at all distances).
  • Implementation – increase in aberrations through refractive/ diffractive changes to the optic surface.Advantages compared to multifocal optics
  • Less glare / halos
  • Less loss of contrast at distance focus

A debate is ongoing among the experts about the final outcome of future development of these new IOLs.
One of the most promising example of EDOF IOLs designed on the basis of spherical aberration studies is the IOL Mini WELL by SIFI Medtech, launched on March 2014.
Mini WELL is a preloaded, aspherical, progressive IOL for mini-incision, with Extended Depht of Focus, providing a better visual outcome than conventional diffractive IOLs.
Mini WELL optics is based on a patent, which is a property of SIFI Medtech (US 8,529,559 e WO2009058755).
A clinical trial is currently in progress and its first results seem very promising.
We will update our Readers about the final report.
A chance to know more about this technological innovation has been the satellite symposium  “Presbyopia: the beginning of a new era”, held in Barcelona on September 7th , at ESCRS Congress 2015

Read this article in Italian

For further information you can read our review about presbyopia surgery:
New EDOF IOLs for presbyopia correction
New horizons in presbyopia surgery
Biometry and success in cataract refractive surgery
Presbyopia and economic growth


Carmelo Chines
Direttore responsabile l'Oculista