Small Aperture IOLs: A Boon for Patients with Irregular Corneas or Difficult Cases

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The IC-8 Apthera intraocular lens (IOL) is a small-aperture, wavefront-filtering lens with an extended depth of focus design that may be the best solution for irregular corneas and challenging eyes, according to Eric Donnenfeld, MD, who described his experience with this technology at the Hawaiian Eye meeting in Maui. He is a founding partner of Ophthalmic Consultants of Long Island, Garden City, NY, and Clinical Professor of Ophthalmology New York University.

A caveat regarding this IOL is that patient selection is important, he pointed out.

“The small aperture design provides uninterrupted, extended depth of focus for cataract patients. Targeting for a small amount of myopia in the small aperture IOL eye improves the near vision while maintaining distance,” he commented.

Potential for small aperture optics in practice

In his hands, this IOL technology can be used to treat both patients with regular and irregular corneas. In those with regular corneas, he uses The Apthera IOL for to achieve successful phakic monovision, for patients with 1.5 diopters or less of corneal astigmatism, and to upgrade patients who want a range of vision after choosing monofocal for their first eye.

In the presence of irregular corneas, the IOL works for patients with a clear central corneal zone, for non-trifocal candidate patients who want additional near vision. However, he pointed out, “The more complex the eye the lower the postoperative quality of vision is. The results with the small-aperture optics will be better than those achieved with a conventional IOL, but surgeons should not expect perfect outcomes.”

In addition to the correction of 1.5 D of cylinder, the IOL will correct 0.75 diopter of sphere.

In his practice, Donnenfeld reported that the most common indication is in patients who have undergone a previous LASIK procedure and want correction of high myopia, hyperopia, or a decentered ablation.

He explained that patients want additional near vision but are not good candidates for a trifocal IOL. The goal is to achieve -0.75 D of myopia in the non-dominant eye and the patients can achieve J1 to J2 vision.

“The Apthera Small Aperature IOL provides the best opportunity to improve vision and distance and near in some of the most challenging patients in our practice,” Donnenfeld concluded.