Osher: Our first video shows a novel thermomechanical
adjustable intraocular lens produced
by Doctors Ruth Lapid-Gortzak
and Vadim Shmukler, a collaboration
between Israel and the Netherlands.
Lapid-Gortzak: Welcome, I'm going
to take you on a journey into the development
of a new intraocular lens technology.
Every time we do cataract surgery and implant
an IOL, we want to reach emmetropia
and we have a lot of formulae to do that.
And every year we get new formulae
that must be better and better.
We have web-scraping technologies
to help us in choosing the correct IOL,
but then when we look at registry studies, for example,
from the Eurequo from Europe, we see
that in 28.8% we have an off target
of at least a half diopter in our patients,
and in 7% it's even more than 1 diopter.
How come that we do not hit emmetropia every time and again,
and that's because we have a patient involved.
The patient has healing, the cornea has to heal,
the IOL is settling into the bag.
The toric lenses may set in a little bit off axis,
our patients get older
and they get an against- the-rule astigmatism.
There are a lot of reasons for us not to have a patient
that complies to the formulae rules
of IOL calculations.
What do we need, you and I, the cataract surgeons?
We need an adjustable IOL.
We need a technology that allows us to make sure
that postoperatively we can adjust the power of the lens
with a non-invasive procedure, making sure
that our patients are on emmetropia
or the target refraction that they want,
and that this is for the patient's lifetime.
And that we can do this in office with equipment that all
of us have in our offices without the need
for expensive proprietary equipment of other technologies.
We would like to present an adjustable IOL,
the VaLENS. Valence is power in Latin,
and what our lens does is it will achieve emmetropia every
time and over time when needed.
Our lens is a foldable lens comprised of a hydrophobic
or a hydrophilic haptic
and optic in which nitinol technology is
embedded in a cradle.
We use nitinol in the mechanism.
Nitinol is a metal alloy of nickel and titanium
and you can program it at specific temperatures
to make specific movements.
And like this, we can move the lens into the
direction that we need.
Nitinol is a well-known metal alloy
that has been used in many medical devices.
Think of cardiac stents, think of glaucoma implants,
retinal chips, for example.
So this is a biocompatible metal alloy.
The mode of action of our lens is
that the moment the lens is in the eye
and there is a residual refractive error,
we will see the patient behind a green continuous laser,
an argo laser in ophthalmo-speak.
And then we will activate the actuators on the mechanism,
and this will allow for a radial movement for the toric
component or an anterior posterior movement
for the spherical component.
We have achieved several of those milestones already,
and I will show you those in the following video.
In the animation, one can see the adjustable IOL, the optic,
the haptics, and the nitinol mechanism being folded into a
cartridge and then advanced into an injector
and then implanted into the bag of the lens.
Upon implantation,
the IOL unfolds and settles into its place.
In the event of a postoperative residual refractive error,
the pupil is dilated, the patient placed at the slit lamp
with the continuous green laser.
The pupil dilatation exposes the actuators,
the aiming beam allows precise activation of the actuators
by the continuous green laser,
and the IOL is shown to move clockwise
and counterclockwise directions.
Our first milestone is the in vitro activation
of the mechanism.
The IOL is placed within a water chamber mounted on the slit
lamp of the continuous green laser.
With the laser, the actuators are heated,
the nitinol lever lifts
and advances the optic in the clockwise direction.
This process is repeated on all actuators.
The process is also demonstrated in the
counterclockwise direction.
The movement is in a 1-degree movement.
The VaLENS adjustable IOL prototype was implanted into the
eye of a New Zealand white rabbit. One week postop
under sedation, in vivo activation of the toric mechanism
and clockwise and counterclockwise movement is shown.
The next milestone is the spherical adjustable component.
This is a ring mechanism with actuators that allow backward
and forward movement of the optic in relation
to the haptic plane,
as shown in the animation. At the left bottom,
you can see the schematic drawing of the backward movement
In an in vitro lab actuation,
the anterior, posterior,
and posterior-anterior movement is shown
by showing the mechanism from the front on the left half
of the screen and the side view
on the right side of the screen.
Activation shows a movement of the optic ring in relation
to the haptic plane anteriorly and posteriorly.
Another important characteristic
of our lenses is the foldability.
We can fold it into an off-the-shelf cartridge
and inject it into the eye
through a 3-millimeter incision.
You can see here how the lens is injected from the cartridge
and has successful unfolding into the petri dish.
Summarizing, we're developing
adjustable IOL technology that will empower you
and me as cataract surgeons to achieve emmetropia every time
that we do the surgery.
Our technology is using off-the-shelf technology
for implantation
A technology, a laser technology
that exists in every office that we have
and allows us to achieve emmetropia
to achieve better outcomes for us
and to the benefit of our patients.
Thank you.
-: [Packard} Hi, my name's Richard Packard
and I've known Bob Osher for a very long time.
He's asked me to say a few words
to mark the 40th anniversary of the audiovisual journal
of originally cataract and then refractive
and now glaucoma surgery
that he started all those many years ago.
This is a most extraordinary achievement
and it is a very, very significant aspect
of teaching in ophthalmology and in cataract
and refractive and glaucoma surgery.
I've collected the output from this audiovisual journal
for most of those 40 years.
Started off as videotape, then went to CD and DVD,
and now it's all online.
It traces the extraordinary changes in innovations
that there have been in cataract, refractive,
and glaucoma surgery over those 40 years,
and it is a great tribute to Bob Osher that he's been able
to record all of these and bring them
to such a huge audience across the world.
Well done, Bob. Carry on the good work. [Osher] Thank you, Richard.