Intraocular lenses: Beyond investigation

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Towards the second half of last year Topcon announced its acquisition of the glaucoma and retina related assets of OptiMedica, the company behind the PASCAL (pattern scan laser) system for retinal photocoagulation. This marked just one of the several recent steps in the company's expansion into surgical territory. Over the past year the company has also been making significant inroads into the intraocular lens world.

Intraocular lenses have developed significantly in recent years and are now available in forms capable of correcting cylindrical error as well as going some way towards presbyopic correction. Topcon is now the sole distributor in the UK of the German Oculentis range of IOLs. The Topcon-distributed Lentis Mplus Toric is an example of a toric IOL capable of being stable enough in place to offer successful correction of astigmatism (Figure 1). Standard versions of the lens offer correction of over five dioptres of cylinder with customised versions also available.

At last year's European Society of Cataract and Refractive Surgeon's conference in Paris there was considerable interest in the Lentis Mplus lens, which offers a novel approach to presbyopia correction (Figure 2). By having a dedicated near vision zone with soft transition from the distance zone, the lens is in effect a simultaneous vision lens but is completely pupil independent. Reliance on refractive correction as opposed to flexing or movement allows correction of up to an equivalent of a 3 dioptre addition. Ongoing trials with the lens will be published in the coming months, but one multicentre study by Professor Auffurth and colleagues at Heidelberg University on behalf of Oculentis looked at Mplus performance in 119 eyes of 72 patients. The mean age of patients was 68 years in a range of ±12 years and the average refractive correction was +22DS ±2.1DS. Subjective ratings of satisfaction during the follow-up period scored 95 per cent. At the three-month follow-up the best corrected distance acuity was found to be 0.01 logMAR (±0.14), while uncorrected near acuity was found to be 0.08 logMAR (±0.17).

Further follow-up of 66 eyes by the team showed impressive satisfaction scorings in a variety of environments (Table 1) and adverse events typical of presbyopic IOL correction were consistently lower than 10 per cent in almost all instances (Table 2). Both lenses are injectable via a minimal entry site (Figure 3), helping to reduce possible postoperative complications.

With recent acquisitions including the Pharo range of phacoemulsification equipment from ARC Laser of Germany, it would appear that Topcon is increasing its surgical presence. ?