Spotlight ON TECHNOLOGY & TECHNIQUE

iSert: A Disposable Pre-loaded IOL System

By Leslie Goldberg, Associate Editor

Hoya's iSert Aspheric Pre-loaded IOL system streamlines cataract surgery from IOL preparation to insertion, proponents say. The iSert system is preloaded with either a UV-blocking or blue-blocking aspheric, glistening-free, hydrophobic acrylic IOL. The single-use inserter is NTIOL approved and can be discarded after IOL implantation.

About the Injector

“iSert initially caught my eye because a preloaded lens can eliminate potential problems,” says Uday Devgan, MD, of Devgan Eye Surgery in Los Angeles. “It is loaded properly every time and maintains a clean and sterile environment. Additionally, when we grab a lens to load it into an injector, the optic is typically grabbed, and this can result in a focal defect,” said Dr. Devgan. “This doesn't happen with a preloaded lens because there is no need to touch it with forceps since everything is self-contained.” He says another advantage is that users don't have to assemble many parts. “With your typical lenses, you have to get the injector cartridge, which is disposable, the metal injector, which is not disposable and has to be sterilized, and the lens and then assemble it all.”

“A disposable injector is a great advantage,” says William Wiley, MD, of the Cleveland Eye Clinic. “Though our practice has never experienced a TASS occurrence, TASS has often been traced back to the injector. One-time use decreases the potential of introducing toxins or microbes into the eye and eliminates the risk of cross-contamination.”

About the Lens

“This lens has a novel design which may have an advantage over a single-piece acrylic lens,” notes Dr Devgan. “The FDA-approved one-piece lenses are all acrylic, including the haptics. This makes it easy to manufacture, but it limits the placement since all single-piece acrylic lenses must only be put in the capsular bag. You cannot put it in the sulcus because the haptics are too thick and lack the firmness for stability in the sulcus.”

The Hoya lens is a novel design in which PMMA is fused to an acrylic center and a machine lathes the entire piece at one time. It is a two-piece lens, but because the pieces are permanently fused together, it has the benefits of a single-piece lens with the placement flexibility of a three-piece lens. Since the PMMA haptics are thin and firm, the Hoya lens is well-suited to a variety of placement options: in the capsular bag, in the ciliary sulcus, in the sulcus with optic capture through the capsulorhexis, or even sutured to the back of the iris.

There is some debate regarding clear lenses and those with a slight yellow tint to filter some of the higher energy blue light, says Dr. Devgan. Hoya says it provides surgeons with both choices so that they can tailor the lens to the patient or to their surgical preference.

Dr. Wiley is a fan of the Hoya lens as well. “This two-piece lens system increases stability in the eye. While it's true that a one-piece is very forgiving if it has been loaded incorrectly, having the IOL preloaded evens the playing field and I am putting a superior optic in the eye and using a sub-2.5 mm insertion.”

Dr. Wiley also says there is significant time savings with the iSert system. “In a higher volume practice, it takes 30 seconds to a minute to load an IOL. That can mean 10% of your time is spent loading compared to the rest of the case.

Figure 1. The iSert IOL system consists of a hydrophobic acrylic IOL with a 6.0 mm optic in a pre-loaded injector. Pushing the injector plunger automatically folds the IOL and allows implantation through a sub 2.5 mm incision.

He says that the iSert can be a bit temperature sensitive — getting a little stiff if stored in a cold temperature, but as long as it's stored at about 70 degrees, there is no problem.

Dr. Wiley is currently using the Hoya lens in approximately 80% of his cases. Because he uses WaveTec's ORange, which provides intraoperative wavefront aberrometry, he can pull three lens choices, all preloaded, and it becomes a very easy process to switch an IOL selection.

Dr Devgan summarizes, “Hoya has successfully given us a high quality acrylic IOL in a pre-loaded injector. In the future, I anticipate that many IOLs will incorporate a preloaded design to simplify surgery and improve outcomes.” OM

For more information, visit www.hoyaoptics.com. You may also click here to view a case performed by Dr. Devgan.