A legacy of innovation

New technology toric and presby IOLs build on OPHTEC’s patient-focused tradition

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OPHTEC President and CEO Erik-Jan Worst
After introducing the Artisan iris-claw phakic intraocular lens more than 30 years ago, the late Jan GF Worst MD faced a challenge. Surgeons from all over the world needed training on implanting the new lens – but it took half a dozen weeks and half a dozen signatures to schedule operating room time at the local hospital. So, Dr Worst prevailed on his wife and business partner, Anneke Worst-van Dam, to build an outpatient surgery centre next to the manufacturing plant they had built in Groningen, the Netherlands, after founding OPHTEC BV in 1983. Still today as a community clinic staffed by six ophthalmologists, that centre continues to shape the company’s products, says OPHTEC President and CEO Erik-Jan Worst. “We do engineering while sitting next to a doctor. Our connection to the surgeon is as close as you can imagine,” said Mr Worst, who grew up in his parents’ business. The live surgery centre next door also keeps workers focused 100% on patients, Mr Worst added. “You don’t make something that ends up in a box and eventually gets in somebody’s eye; no, you actually see the patient walking out with the patch on their eye. We are very close to the reality of surgery. If we have a problem we know right away, and if [a product] works well we also know.” DEEP INSIGHT YIELDS NEW PRODUCTS Constant dialogue with practising surgeons helped OPHTEC as the firm focused on improving cataract surgery lenses in the past few years, Mr Worst said. The first target was making toric lenses less sensitive to rotation and pupil size. The problem is optics, Mr Worst said. Most toric lenses use an aspheric main optic, but a spheric cylinder optic. The resulting optical interaction produces a narrow cylinder correction that diminishes in power along meridians as it moves away from the lens centre. This makes the lens very sensitive to misalignment with the axis of astigmatism, particularly as the pupil dilates in darkness, exposing peripheral cylinder correction that is narrower and less powerful than the central correction. The optical interaction of spheric and aspheric elements also causes glare and halos, which worsen at night. OPHTEC’s solution is the patented Transitional Conic Toric (TCT) optic included in the new Precizon Toric IOL. It incorporates an aspheric cylinder correction into an aspheric optic using a conic profile with continuous transition between zones of differing power. This produces an optic with uniform power along the length of all meridians, which makes the correction independent of pupil size. It also widens and increases the power of the cylinder correction zone at the periphery, making the lens more forgiving of rotational misalignment. Transitional blending also greatly reduces glare and halos, and extends depth of focus, Mr Worst noted. Sales have increased dramatically as the advantages of the design are recognised, particularly for improving night vision, he added. Developed with assistance from Jaume Pujol PhD, of the Polytechnic University of Catalonia in Barcelona, a similar blended optic known as Continuous Transitional Focus (CTF) is incorporated into OPHTEC’s Precizon Presbyopic IOL, which is planned for commercial launch this year. The lens provides blended transitions between multiple far and near focus areas across its surface, extending depth of vision and providing broad, clear retinal images across a wide, continuous range of defocus, Mr Worst said. Similar to the Precizon Toric, the presby lens is more forgiving of decentration and tilt than conventional diffractive or refractive multifocal optics, Mr Worst added. Precizon Presbyopic “has the least halos and glare in the marketplace, which is one of the most common complaints about multifocal lenses”, he said. Developing these innovative toric and multifocal optics involved a long period of trial and error, Mr Worst said. Because human vision is so complex, moving from a model that looks good in bench testing to one that really works in patients’ eyes required endless adjustments. Prototypes were installed in cameras and used by engineers around the office and outside, and the designs were altered to compensate for problems that emerged. “With multifocal lenses, you compensate.” OPHTEC plans to make the CTF optic available in an Artiflex lens, allowing phakic patients to benefit. But effective as the Precizon Presbyopic may be, it can be improved, Mr Worst said. “We are convinced that no one multifocal lens solution fits all patients. You need to be customised. You get your data and you make a lens for that patient, a customised solution. That is where we are going,” Mr Worst said. However, current regulatory practice makes gaining approval for a customised approach difficult. Still, pursuing such innovation honours his father’s legacy, Mr Worst concluded. “He was a person who could think outside the box. He could think about things other people would not accept as quickly. You’re always wrong when you’re right too early.”