PubMed2006
PURPOSE OF REVIEW: Technology exists today that could permit refractive precision unheard of at the present time plus the correction of higher-order aberrations and restoration of accommodation in presbyopic adults. RECENT FINDINGS: With the light adjustable lens, after surgery, the shape of the lens can be customized to treat spherical, cylindrical and other higher-order aberrations. The posterior surface of the lens can be adjusted to create both refractive multifocality and diffractive bifocality. It can be made out of a variety of materials, some of which can be injected into the capsule, filling it, thus replicating the original shape of a crystalline lens. While the current technique of bag filling does permit the less viscous materials to leak out of the bag this is a solvable problem. For example, a disc can fill an ordinary-sized capsulorrhexis opening, allowing removal of the cataract using standard techniques and filling behind this disc. Also the material, once injected, could be polymerized. Posterior capsule opacification is also potentially solvable with devices that completely destroy lens epithelial cells or through a polymerization process of the new lens material in which the reaction destroys the capsular cells and actually binds to the capsule. SUMMARY: It is apparent that light adjustable lenses plus injectable technology, and multifocality can produce precise refractive correction and, hopefully, the type of accommodative range that we take for granted when we are young. Combining these technologies with a lens material that behaves like a crystalline lens of a 25 year old could precisely return near and distance vision to older adults.