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IOLs: The State of the Industry
Manufacturing leaders expect continued IOL sales growth and technological innovation.
BY JOHN PARKINSON, ASSOCIATE EDITOR

The enormous growth of the IOL market in recent years has revolutionized the anterior segment side of ophthalmology. Continuous innovation has created a boom market for ophthalmologists with new presbyopia-correcting IOLs as well as with emerging products such as toric and aspheric IOLs.

With much buzz and excitement surrounding IOLs today, Ophthalmology Management asked industry leaders to share some of their insights about the major IOL trends today and where the market is headed.

Monofocals vs. Presbyopia-Correcting IOLs

With the introduction of multifocals and accommodative IOLs, one may begin to wonder if monofocals' days are numbered. However, industry leaders predict that standard IOLs will continue to be on the market for years to come.

Mike Judy, vice president of eyeonics (Aliso Viejo, Calif.), believes some patients may be satisfied with a standard monofocal for economic reasons or matters of choice.
"I think there will be patients out there who won't require or see the benefit of addressing their presbyopia, while a significant portion of the emerging baby-boomer generation will have a strong desire to address their visual needs."

Jim Mazzo, president and CEO of Advanced Medical Optics (AMO, Santa Ana, Calif.), says some market share will shift away from monofocals to presbyopia-correcting IOLs, but because physicians have a variety of considerations when deliberating treatment options for patients, he says it is better to offer doctors more choices than just a one-size-fits-all solution.

Cary Rayment, chairman, president and CEO of Alcon (Fort Worth, Texas), has a similar belief. "I believe there will always be a market for monofocal IOLs, and that these technologies will coexist, offering surgeons multiple options to provide patients with the vision that fits their lifestyle."

Henry Tung, M.D., vice president of Global Surgical for Bausch & Lomb (Rochester, N.Y.), also believes the CMS ruling has greatly influenced the presbyopia-correcting IOL business segment and will help it continue to grow at a great pace from its estimated $85 million worldwide today, to somewhere in the $500 to $750 million in the next 5 to 8 years.

CMS Ruling

Last year's CMS decision on "patient-share" billing, with patients paying a premium for presbyopia-correcting IOLs, has made a major impact in the IOL market. David Bailey, president and CEO of STAAR Surgical (Monrovia, Calif.), says it has changed the way surgeons and patients view cataract surgery.

"Reimbursement [patient-share billing] is really a way to change a chronic procedure to an elective one," explains Bailey.

"The recent decision by CMS recognizes the need to provide patients greater access to ever-advancing technologies. Over time it is likely that cataract surgeons and their patients will expect one lens to deliver all of their visual needs, and patients will be willing to pay out of their own pockets for that," predicts Rayment.

Ongoing Trends

Many patients are aware of modern ophthalmology's capabilities and want more than just to be able to regain some visual acuity. Mazzo says today's cataract candidates are still living active lives and have different expectations than people did a generation ago. "Just having good vision is not acceptable," says Mazzo. "They want the 20-year-old eye."

As expectations have changed, IOL manufacturers are integrating various capabilities into single technologies to address multiple refractive and visual issues. Alcon, for example, has developed an IOL to address astigmatism.

"Pre-existing astigmatism continues to be an issue for cataract surgeons and their patients, and existing surgical procedures and IOL designs do not deal with it optimally," says Rayment. "For this reason, Alcon developed the AcrySof Toric IOL that gives cataract surgeons another IOL technology to provide better visual outcomes and raise patient satisfaction."

Another example is AMO's Tecnis IOL. It was granted NTIOL status by CMS earlier this year, and combines an aspheric lens design with a multifocal to combat contrast sensitivity issues like night driving. AMO hopes for a U.S. release of its Tecnis multifocal either next year or in 2008.

Not only have patients' expectations changed, but so have surgeons, says Bailey. "The whole trend in cataract surgery is in customized outcomes with quality of vision and ease of management for the surgeon without touch-ups or secondary procedures."

More Solutions for Patients with Presbyopia

The presbyopia-correcting IOLs in the market today have helped patients regain near, far and immediate visual function and greatly improved the quality of their lives. And while this technology will continue to help ophthalmologists meet the needs of their patients in the coming years, industry leaders agree continuous refinement of the present IOLs, as well as development of new technologies, is an integral part of corporate strategy.

"I think there will be a trend toward newer technology out in the marketplace, and there will be enhancements to the current technology," explains Judy. Specifically, he predicts more funding for research and development in further advancing accommodative lenses.

Dr. Tung views the present presbyopia-correcting IOLs as important first-generation technology. He believes the next generation will focus on creating lenses that exhibit accommodative qualities. Looking even further in the pipeline,
Dr. Tung says B&L will be developing IOLs that could potentially outperform accommodatives.

"Next year, we'll be starting another program based on a different technology platform that will be the generation after accommodating IOLs. They will have some characteristics superior to accommodating lenses," explains Dr. Tung.

Bailey foresees a greater penetration of the market with presbyopia-correcting IOLs, but he believes a finer refinement of the present technology must first occur.

AMO is developing two accommodative IOLs, which the company hopes to introduce within the next decade.

"The new accommodative IOLs will be the next big platform because that is still the largest population— the presbyopic patient," explains Mazzo. "Multifocals are [beneficial] but won't be able to meet everyone's needs. Accommodative IOLs will be the overall greatest growth driver probably entering 2010 and beyond."

The Road Ahead

Competition between IOL manufacturers will heat up as the race to get into this market becomes more crowded. Along with innovation from existing IOL manufacturers, new companies will look to develop products and bring them to market. As more IOL offerings with multiple capabilities come to market, physicians will need to stay informed about the latest products. In the end, more options for surgeons afford them an opportunity to deliver better visual outcomes and have more satisfied patients.