March 2009

 

CATARACT/ IOL

 

Talking Tecnis one-piece IOL


by Maxine Lipner Senior EyeWorld Contributing Editor

   

Focusing on how practitioners view the new lens

one-piece, 360-barrier optic haptic junction

Tecnis one-piece polished haptic

Tecnis one-piece

Tecnis one-piece profile Source: Y. Ralph Chu, M.D.

Say the word Tecnis (Advanced Medical Optics, AMO, Santa Ana, Calif.) and for many that brings to mind a call to low spherical aberration, making for particularly good vision in dim light. Back in April 2008, a new one-piece version of the lens became available here in the United States. Here’s the scoop on what to expect with this innovative one-piece lens.

Early experience

Y. Ralph Chu, M.D., medical director, Chu Vision Institute, Edina, Minn., sees the one-piece Tecnis as offering three main advantages. First of all, Dr. Chu, who was one of the investigators in the Food and Drug Administration (FDA) trial of the lens, finds that it centers very easily. “It is the new generation of one-piece design in that it has a special coating on the lens that makes it less sticky,” he said. “So the haptics unfold much easier than previous generation one-piece lenses upon insertion, especially through a very small incision like one that is 2.5 mm.”

Secondly, the lens is also designed with offset haptics to help keep posterior capsular opacification (PCO) at bay. “The haptics and the optics are in a different plane so that the optics fit more tightly against the posterior capsule, which kind of emphasizes the 360-square edge barrier even at the haptic/optic junction,” Dr. Chu said. “That minimizes PCO.”

Thirdly, the quality of vision with the lens is exceptionally high. In Dr. Chu’s experience he finds that patients are often surprised by the clarity of their vision. “We knew that the Tecnis optical surface was proven in previous FDA and other trials,” he said. “But what surprised me was that a lot of patients said, ‘Wow, I really like the vision through this lens.’” When investigators looked into these anecdotal reports they found that the hydrophobic acrylic material used for the lens was helping to improve acuity. “The material itself has a very low chromatic aberration,” Dr. Chu said. “Studies have shown that if you reduce spherical aberration you can improve contrast by 25%, and if you add low chromatic aberration to that low spherical aberration you improve it by 50%.”

A later view

Robert J. Noecker, M.D., associate professor and clinical affairs vice chairman, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, finds that his patients like the quality of vision that results. “The biggest attraction of the Tecnis is the superior optics,” he said. “I deal with a population that has a lot of glaucoma so there’s not a lot of good visual acuity. For me the superior optics is really the big selling point both for the original Tecnis and the three-piece prior version.” He began using the IOL just after its FDA approval in the United States and now describes it as his “lens of choice.” In Dr. Noecker’s experience the lens is also easy to insert and has a “forgivingness” about it in the eye. “Arguably it’s the best of both worlds,” he said. “I think it has the best optics, and in terms of placement and ease of use, I think the one-piece platform makes it pretty desirable.”

He finds that the lens is easy to insert. “I have my fellows and residents insert it with me. I often use them as a marker on how easy or difficult a procedure is,” he said. “They used this lens without difficulty.” It also tends to be easier on the patient’s eye. “It’s less traumatic. The way the material is for these one-piece lenses, they tend to open up a little bit slower and tend to be gentler versus the PMMA haptics of the three-piece version, which the nurses may also be more likely to break,” he said. “Or if there’s a defect in the capsular bag the three-piece lens is a little more traumatic to it.”

In Dr. Noecker’s experience, the one-piece Tecnis lens is very versatile and can also be inserted using any device. “The nice thing about it is, off label of course, it goes through any inserter,” he said. “So you can use prior Tecnis platforms for IOL insertion with the unfolder, or I have used it with other branded lens insertion techniques and it works.”

The IOL is also simple to center. “It opens up relatively slowly,” Dr. Noecker said. “So you have time to manipulate it if it’s not in the perfect position, or if you want to try to get out residual cortex it’s easy to reposition.”

Dr. Chu likewise is impressed with how easy the lens is to implant. “If a surgeon has implanted a three-piece acrylic lens before transitioning to the one-piece, it is a piece of cake,” he said. “I think with all lens insertion the one-piece is much easier.” To avoid complications he recommends that practitioners pay attention to where the haptics are inside the cartridge. “When you are using the AMO injector cartridge, making sure that the haptics are on top of the optics and out of the glide path will basically ensure a smooth insertion every time,” he said.

Outcomes with the lens have been promising. Dr. Noecker has only had one early case in which a haptic was inadvertently torn off during insertion by one of the scrub nurses. He found that retrieving it was no problem. “Removing it from the eye is quite easy,” he said. Patients enjoy good vision. “Once it’s in the eye it stays in a very stable position and is kind of self centering,” he said. “It does very well post-operatively unlike lenses in the past five or ten years. With those it was not uncommon to have post-operative complaints of halos and other optical aberrations.” Dr. Noecker has never had any such complaints with the one-piece Tecnis lens.

In Dr. Chu’s experience, results have been excellent continually. “Consistent with what we saw in the FDA clinical trial, acuities are very predictable and there is an improved quality of vision,” he said. He also continues to be impressed by the ease of use of the lens. “I think that the Tecnis one-piece does represent a step forward in one-piece lens design,” Dr. Chu said. “I think that surgeons will notice immediately how easily the haptics unfold and how easy the lens is to insert. I do think that it is an advance.”

Editors’ note: Dr. Chu has financial interests with Advanced Medical Optics (Santa Ana, Calif.), Allergan (Irvine, Calif.), and Bausch & Lomb (Rochester, N.Y.). Dr. Noecker has no financial interests related to his comments.

Contact information

Chu: 952-835-0965, yrchu@chuvision.com
Noecker: 412-647-2152, noeckerj@upmc.edu

Talking Tecnis one-piece IOL Talking Tecnis one-piece IOL
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