November 2009




Perspective in Lens and IOL Surgery

The Akreos MI60 creates a new standard in monofocal lens technology

by Louis D. Skip Nichamin, M.D.


Skip Nichamin is one of the busiest and most skilled anterior segment surgeons in the country. In this month’s column he discusses his experience with the Bausch & Lomb Akreos MI60 microincision IOL (Rochester, N.Y). This lens is the first sub-2.0 mm incision IOL available in the US and represents an incremental improvement in IOL technology. His vast experience with this IOL should be enlightening. This foray into sub-2.0 mm territory begs the question – how much smaller can we go?

B&L Akreos MI60L MICS IOL 12 days post-op Source: Jack Singer, M.D.

In a nutshell, I think Bausch & Lomb’s Akreos MI60 IOL (Rochester, N.Y.) is the most advanced monofocal implant that we have available in the United States.

It is going through the smallest incision (1.8mm) of any IOL by quite a bit and its overall performance today has been exemplary. The lens is a single-piece design made of a very advanced hydrophilic acrylic material that has no glistenings in it. It’s extraordinarily optically clear and like its parent design, the Akreos AO, it features the Advanced Optic lens, which has an aspheric, aberration-free design, with aspheric anterior and posterior surfaces that do not create spherical aberrations.

Having had a good experience working with the Akreos AO, I’ve found that the MI60, a fifth generation Akreos IOL, which is 30% thinner than before, performs as well if not better than its predecessor.

One of the beauties of the earlier model Akreos AO was its sturdiness and how reliable it was in the way it filled the capsular bag. I’ve found that we’ve sacrificed nothing by going to this thinner MI60 modification. I’ve been extraordinarily impressed as to how well these incisions seal and there’s no question we have reached a truly astigmatically- neutral incision. But even beyond the astigmatic ramifications of the smaller incisions, what’s most important to me is how safe these incisions are. They just will not leak. It’s like creating a paracentisis incision with what has traditionally been our side-port ancillary incision. It basically looks like our main incision today, so the advancement that we’ve achieved with this technology is exceptional.

Additionally, in response to the move towards reduced-aberration lenses, this is a lens designed not only to impart no aberration when properly placed, but even in the very unlikely circumstance that it becomes decentered or tilted, it will still not induce any additional aberration.

Patient selection

Because the Akreos MI60 IOL incorporates an aberration-free optic, it can be used for a very wide-range of eyes. I’m using it on essentially everyone today. Based on the material, its design, and incision, it has become my primary monofocal implant. The only patients I don’t use it on are individuals who are receiving a premium presbyopia-correcting IOL. I should note that this is a capsular bag lens; therefore, it should not be placed into the ciliary sulcus. So if there’s a breach in the integrity of the posterior or anterior capsule and one cannot place the lens reliably into the capsular bag through an intact capsulorhexis, it shouldn’t be used.

The future of monofocal implants

I just think that this lens has raised the bar for the entire industry. I believe that all manufacturers will be striving towards sub-2mm incisions and I think that phaco technology is going to be catching up with our implant technology. I’m fortunate to have access to a 1.8 mm Stellaris phaco system (Bausch & Lomb) so I’m basically operating at a 1.8mm and I don’t enlarge my incision. I believe that in the next decade, all the manufacturers of ophthalmic technology will have phaco and IOL offerings that work within sub-2mm incisions. I believe that that will become our standard.

I think in terms of competing, the Akreos MI60 is going to win over market share from other monofocal implants.

The Akreos MI60 creates a new standard in monofocal lens technology The Akreos MI60 creates a new standard in monofocal lens technology
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