Modular Shape-Changing IOLs

An investigative intraocular lens (IOL) that uses a fluid-filled module to change shape and refractive power remained stable in the eye and demonstrated a wide accommodative range 24 months after implantation, according to Steven J Dell MD.

The OmniVu (Atia Vision) is a dual-optic accommodating IOL consisting of a fluid-filled base that simulates natural accommodation by changing shape in response to ciliary muscle contractions. It is joined with a fixed-power front optic that aims to achieve emmetropia. The combination delivers excellent visual quality throughout the functional visual range, from far through intermediate and near vision at 40 cm, Dr Dell said.

Because the lens is bulkier than a conventional single-optic IOL, it better fills the capsular bag, Dr Dell added. “The goal here is to preserve a more physiological orientation of the anterior segment.”

This orientation may help keep the IOL position and anterior vitreous face stable and minimise posterior capsule opacification, Dr Dell said. It may even increase safety by preventing the vitreous from moving forward, possibly reducing the risk of retinal damage.

Two-year results

A stable, effective lens position is key to long-term refractive stability, and the OmniVu delivers, Dr Dell said. In a prospective, open-label, first-in-human study involving 29 eyes in 19 patients, mean effective lens position as measured by anterior chamber depth varied by approximately 0.1 mm from 1 month through 24 months after surgery.

Similarly, mean manifest refraction spherical equivalent was both accurate and stable, running between 0.0 and 0.3 D and varying less than ±0.5 D throughout the 24-month follow-up period.

“These are some of the best results I have seen for refractive predictability for any IOL, accommodating or otherwise,” Dr Dell said, adding refractive cylinder was also quite stable.

Mean visual acuity was also excellent, with corrected and uncorrected values nearly identical, Dr Dell reported. Monocularly, mean VA was 20/20 for distance and intermediate and 20/25 or J1 for near vision. Binocularly, that improved to 20/16 for distance and intermediate and 20/25 for near vision.

Defocus curves were also broad, spanning 4.7 D above 20/32 binocularly at 24 months. Contrast sensitivity with and without glare was similar to published monofocal IOL data.

Visual disturbances were also minimal, with only mild glare and halos in 1 patient each out of 16 and 2 patients with mild and 1 with severe starbursts, Dr Dell reported. “This is also very consistent with a monofocal visual quality.”

Future progress

Currently, the OmniVu requires a 3.5 mm incision. “I’m not thrilled about that,” Dr Dell said. “I’d like to see that at sub-3.” It also requires a carefully created 5.5 mm capsulotomy, and size and centration are important, he added. The current study and design development are ongoing.

Dr Dell summed up by noting the OmniVu maintained a more physiological anterior segment, remained stable in refraction and astigmatism, provided excellent uncorrected and corrected vision, and delivered continuous focus throughout the functional vision range. “We continue to chip away at this problem of presbyopia with different creative optical solutions, but we all know that ultimately the solution is going to be an accommodating IOL.”

Dr Dell spoke at the 2025 ASCRS annual meeting in Los Angeles.

Steven J Dell MD is an ophthalmologist in Austin, Texas, US. steven@dellmd.com