Keeping the future of ophthalmology open to adjustment and new technologies
Gary Wörtz |
Two years out of my residency, I was frustrated with the disconnect between performing a successful cataract surgery, and achieving imperfect refractive results. I started thinking about why so much refractive variability exists in cataract surgery, and it suddenly struck me that we are removing a 4–5 mm thick cataract and allowing the capsular bag to collapse around a 1 mm thick optic. The final resting position of the optic determines the effective power of the lens. There had to be a better solution than simply leaving this to chance.
My idea? To find a way to keep the capsule in its native extended volume and insert the lens in a way that would provide a defined plane to perform intraoperative measurements and calculations. If we could create a platform to keep the capsular volume essentially unchanged, there would be a much better chance of the lens being positioned in the middle of the bag after surgery. Although cataract volume and capsular bag size differs between individuals, they fall into a fairly narrow range, which led me to design the Gemini refractive capsule: a form-fitting capsule platform made of a flexible silicone polymer that is essentially a ‘one size fits all’ device (see Box: The Gemini Refractive Capsule). The capsule itself doesn’t have any refractive power, but has been engineered to be compatible with all popular available IOLs, as well as compatible with intraoperative aberrometry to ensure accurate refractive outcomes. A channel in the midpoint of the Gemini refractive capsule holds the IOL haptics to maintain the optic in a stable position.
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