Accommodative Intraocular Lens Research Articles

Safety, biocompatibility, and potential functionality of a new accommodative intraocular lens: An experimental study in rabitts

Aims/Purpose: This study aims to evaluate the safety, biocompatibility and functionality of a new accommodative intraocular lens (IOL) (LUZ, Lens Undergone Zonula Global S.L., Valencia, Spain) that, after implantation in rabbit eyes, is compared with a control lens (EyeCee®) and a capsular ring, both present on the market.Methods: LUZ is an accommodative IOL with two parts: one IOL of hydrophobic acrylic material and polymethylmethacrylate (PMMA) and one ring of silicone and PMMA. LUZ (Study) and EyeCee® plus a capsular ring (Control) were implanted in rabbits (𝑛 = 8 each) after lens surgery by phacoemulsification technique to randomly. Intraoperative and long‐term clinical follow‐up, based on complete ophthalmic examination, and functional tests were performed periodically until 180 days post‐implantation. Finally, ocular samples were collected and histologically evaluated. All data was statistically analysed.Results: During macroscopic clinical follow‐up we did not observed significant changes between both groups. The lens studied (LUZ) remained centered and without severe clinical complications. The functional study showed no significant differences between both groups. LUZ showed better centering, few adhesions, and kept the capsular bag open compared to Control IOL. Biological effects of LUZ lens implantation were low and comparable to the control lens.Conclusions: LUZ IOL, has shown safety after being implanted in the rabbit eye, just like the control lens. It has not shown clinical or histological signs that refer to an adverse reaction to the material. Although LUZ functionality has not been observed in the rabbit eye, this possibility should be studied in other animal species with greater and better accommodation. The LUZ lens keeps the capsular bag open, preventing its fibrosis and lens adherence, thus theoretically favouring its potential accommodation.

Direct measurement of the ciliary sulcus diameter using optical coherence tomography: Inter‐rater variability

Aims/Purpose: To develop a method for measuring the exact dimensions of the ciliary sulcus in order to improve the predictability of accommodative intraocular lens sizing.Methods: Patients scheduled for cataract surgery have been pre‐operatively examined with the anterior segment optical coherence tomographer (AS‐OCT) CASIA2 (Tomey, Nagoya, Japan). Optimized scan protocols were defined to improve the image quality of the ciliary structures. The horizontal scan from 0° to 180° was taken to represent the space where a sulcus‐fixated accommodative intraocular lens (IOL), whose diameter must agree with that of the ciliary sulcus, may be placed. The images were corrected for the optical distortion induced by the cornea's refraction. The sulcus‐to‐sulcus (STS) size as well as the depth of the sulcus plane (SPD) was measured using the integrated software calliper by two independent raters. Inter‐rater variability and correlation were evaluated. In addition, STS measurements were compared to other ocular diameter measures, such as angle‐to‐angle (ATA) and anterior chamber width (ACW). Data were analysed by means of correlation coefficient R2 and Bland–Altmann analysis.Results: 55 eyes of 28 patients were included in the study. The optimized scan protocols improved overall image quality and subjective visibility of ciliary anatomy compared to the default protocol. STS ranged from 10.66 mm to 12.89 mm, ACW from 10.76 mm to 12.74 mm and ATA from 10.69 to 12.46 mm. SPD ranged from 3.73 mm to 5.0 mm, while ATA depth was between 2.74 mm and 3.95 mm. Readings of both raters were highly correlated (R2 > 0.98). Manual readings of STS correlated poorly with automated ACW and ATA measurements (R2 < 0.66). The mean difference was 0.018 mm for STS and −0.011 mm for SPD. The levels of agreement were within [−0.109; +0.145] mm for STS and [−0.112; +0.091] mm for SPD.Conclusions: Despite the absorption of light by the iris pigment, the infrared light from the AS‐OCT is able to penetrate the posterior chamber to some degree. Therefore, the new AS‐OCT method for sulcus‐to‐sulcus and ciliary dimensions measurements seems to be feasible, reliable and is less bothersome for the patients compared to ultrasound bio‐microscopy. This approach could be useful for sulcus fixated accommodative IOLs and for sizing determination of posterior chamber phakic IOLs.

Safety, biocompatibility, and potential functionality of a new accommodative intraocular lens: An experimental study in rabbits

This study aims to evaluate the safety, biocompatibility, and functionality of a new accommodative intraocular lens (IOL) (LUZ, patent PCT/ES2016/070,813) after implantation in rabbit eyes. LUZ (Study) and EyeCee® plus a capsular ring (Control) were implanted in rabbits (n = 8 each) after phacoemulsification. Intraoperative follow-up, long-term clinical follow-up, and functional IOL studies were carried out periodically for up to 180 days. A macroscopic examination of the eyeballs to reveal abnormalities and determine the implant centering and a microscopic examination to semi-quantify cell and tissue response were performed. Statistical analysis of the collected data was finally achieved. During follow-up, no significant changes in the general condition nor the clinical evaluation were observed between both groups. However, Study IOL remained centered throughout the study and did not present severe complications as observed in the Control group. Functional studies did not reveal significant differences between both materials. Study showed better centering, fewer adhesions, and maintenance of an opening capsular bag compared to the Control. Local biological effects caused by Study implantation are minimal and comparable to the Control. Therefore, LUZ showed no clinical signs or histological response of adverse reaction to the implanted material, according to UNE-EN ISO 11979-5 and 10993-6. Functionality must be confirmed in another animal species with greater lens accommodation capacity than the rabbit. LUZ keeps the capsular bag open, favoring its centering and avoiding fibrosis and adherence to the bag; this allows potential accommodation of this IOL and theoretically enables the patient to focus dynamically.

Preliminary results obtained by a new intraocular lens based on accommodative technology for the treatment of cataract and presbyopia

AbstractPurpose: The aim of this study was to report the clinical results obtained by a new accommodative intraocular lens (AIOL) in terms of visual acuity, refraction, defocus curve, contrast sensitivity and complications incidence for multiple follow‐up phases.Methods: This is a prospective and experimental study composed by patients interested in an AIOL implantation (Lumina, Akkolens) to improve their visual performance. An exhaustive postoperative follow‐up (1 week, 1 month, 3 months, 6 months, 1 year) was performed including the measurements of visual acuity for multiple distances in decimal notation, subjective refraction, accommodative evaluation by defocus curve, contrast sensitivity and a slit lamp and fundus exploration.Results: The study included 42 eyes of 21 patients (mean age of 61.4 ± 10.9 years; 52% females, 48% males). The mean uncorrected distance visual acuity at week was 0.71 ± 0.28, but it improved to 0.85 ± 0.27 a year after the surgery. Similarly, the mean uncorrected near visual acuity improved for 0.48 ± 0.23 at 1 week to 0.60 ± 0.17 at 1 year. The mean equivalent sphere was −0.39 ± 0.60 diopters and the mean corrected distance visual acuity was 1.04 ± 0.16 at 1 year. For a defocus range comprised between 0.00 and −2.00 diopters the mean visual acuity was better than 0.50. The contrast sensitivity assessment showed values higher than 1.10 log units for all frequencies. Capsule opacification with YAG laser requirement was present in 21% of cases (N = 9). At the end of the follow‐up all minimal complications were resolved.Conclusions: The AIOL Lumina Akkolens provided suitable distance vision and functional near vision improving its performance over time. Contrast sensitivity was good being comparable with a monofocal design, but the Lumina IOL shows better near visual performance as revealed in the defocus curve. Significant persistent complications were not observed. These results will be updated with more patients and will be compared with a control group.

Positive resolution of the wound-healing response in lens epithelial cells by Ti3C2T x MXene coatings for use in accommodative intraocular lens devices

Cataract surgery removes the diseased lens of the eye replacing it with an intraocular lens, restoring visual acuity. However, accommodation, the lens’ ability to provide dynamic change in focus, is lost. A number of accommodative intraocular lens (AIOL) designs have been considered although none have provided a truly effective clinical AIOL. Two-dimensional titanium carbide (Ti3C2T x ) MXene has been used as a transparent conductive electrode within an AIOL feasibility study. Nevertheless, the potential for Ti3C2T x to repress excessive inflammation and promote wound healing following cataract surgery has not been considered. Cataract surgery can trigger chronic inflammation and epithelial-mesenchymal transition (EMT) in residual lens epithelial cells (LECs), producing a fibrotic mass across the posterior capsule known as posterior capsule opacification (PCO). With a large surface area and capacity for surface functionalisation, MXene has properties enabling a dual purpose AIOL design with an additional therapeutic role in the repression of pathways leading to PCO development. In this study, Ti3C2T x MXene was investigated to determine its impact on pathways leading to chronic inflammation and EMT using an in vitro LECs model. Ti3C2T x MXene was synthesised and characterised using UV-vis spectroscopy, dynamic light scattering and scanning electron microscopy. Changes in markers linked to inflammation and EMT in Ti3C2T x -treated LECs were measured using enzyme linked immunosorbent assays, quantitative polymerase chain reaction, scratch assay, RNA sequencing for whole-cell gene expression profiling and lipidomics analysis. Ti3C2T x significantly reduced the expression of pro-inflammatory cytokines by interleukin 1 beta primed LECs and did not advocate EMT, promoting a positive resolution of the wound healing response. This study supports the role of Ti3C2T x within an AIOL design with the potential to repress key developmental pathways leading to PCO.

Self-Adaptive Accommodative Intraocular Lens Enabled by Sunlight-Driven Highly Transparent Liquid Crystalline Polymers

Self-Adaptive Accommodative Intraocular Lens Enabled by Sunlight-Driven Highly Transparent Liquid Crystalline Polymers

A biomechanical model for evaluating the performance of accommodative intraocular lenses

Accommodation alters the shape of the eye lens to change focus from distant to near vision. This function declines with age in the development of presbyopia and most people experience a near total loss of accommodative ability by 55 years. Currently, there are no surgical procedures that correct presbyopia, but considerable work has been done in the development of accommodative intraocular lenses (AIOLs) implanted during cataract surgery. Despite these efforts, AIOLs only restore ∼ 20% of youthful accommodative amplitude and they suffer from high rates of visually-debilitating fibrosis. An important design tool that is lacking that could aid in improving AIOL designs is modeling. Herein, we addressed this need through the development of a fully 3-D finite element model that was used to predict the behavior of a dual-optic AIOL implanted within the post-surgical lens capsule. Models of the native human lens were developed to identify the stress-free configuration of the lens capsule needed to accurately predict the accommodated state of the lens and the configuration of the zonular traction needed for the disaccommodated state. The AIOL model demonstrated the functional importance of implant stiffness and predicted an approximately linear relationship between zonular traction magnitude and axial displacement of the optics. To our knowledge, this is the first model that can be used to gain insights into AIOL efficacy. It provides a foundation for continued development of a predictive tool that could ultimately improve AIOL designs that seek to restore youthful accommodative function.

Encouraging Visual Outcome of a New Accommodative Intraocular Lens: A Retrospective Long-Term Study with a Mean Follow-Up of 5.3 Years

Purpose: To assess the visual outcome after implantation of the new Hydrophylic IOL type 41 B/G accommodating intraocular lens (AIOL). Methods: The presented lens was implanted during cataract surgery. All patients were offered follow-ups, allowing two postoperative measurements to be performed at 3 months and between 2020 and 2021. The mean time between lens implantation and last follow-up was 5.3 years (min. 1 year, max. 10 years). Excluded were patients with age-related macular degeneration or amblyopia. Patients with a foreign lens implanted into the second eye were included in a separate control group. Corrected distance (CDVA) and uncorrected distance visual acuity (UDVA) at 5 m, and corrected near (CNVA) and uncorrected near visual acuity (UNVA) at 40 cm were assessed. Furthermore, the postoperative spherical equivalent (SE), the dependence on spectacles and the occurrence of optical phenomena were evaluated. Results: The final study cohort consists of 65 patients with 119 implanted AIOLs. Significantly better visual results were obtained in both postoperative follow-ups compared with the preoperative results. The mean values of the last follow-up for the UNVA, CNVA, UDVA, and CDVA were 0.107 ± 0.10; 0.039 ± 0.08; 0.097 ± 0.11; and 0.040 ± 0.09 logMAR, respectively. Visual outcomes remained on a high level for up to 10 years and showed significantly better results compared to the control group. Postoperative SE was significantly improved. Nearly 70% of patients were no longer dependent on glasses. Furthermore, the occurrence of disturbing optical phenomena was denied by all patients. Conclusion: The results of this AIOL are particularly promising, especially since gratifying visual results could still be measured 10 years after implantation.

Encouraging Visual Outcome of a New Accommodative Intraocular Lens: A Retrospective Long-Term Study with a Mean Follow-Up of 5,3 Years

Encouraging Visual Outcome of a New Accommodative Intraocular Lens: A Retrospective Long-Term Study with a Mean Follow-Up of 5,3 Years

Intraoperative Measurement of Crystalline Lens Diameter in Living Humans.

There are no reports on accurate measurement of lens equatorial diameter of the living human eye. This study aimed to measure lens equatorial diameter with a special measurement device during cataract surgery and examine the relationships with preoperative parameters. From April 7 to December 1, 2019, the equatorial diameters of 24 eyes from 24 patients who underwent cataract surgery at Kushimoto Arita Hospital were measured with a loop shaped measurement device during cataract surgery. Correlations between the value of the diameters and various preoperative parameters measured by CASIA2® were evaluated. The average value of the measured equatorial diameter using the device was 10.5 ± 0.4 mm and the value estimated by circular approximation using the CASIA2®️ was 10.1 ± 0.7 mm. A significant difference was observed between these two groups (P = 0.016), and only a weak correlation was observed (γ = 0.31). A positive correlation was observed between equatorial diameter and anterior chamber depth (ACD) or anterior chamber width (ACW) (γ = 0.57 and 0.47, respectively). No significant correlation was found between other parameters and the value measured by the device. Our method is a completely new approach to measuring the living human lens equatorial region of the eye. No complications were observed in any of the cases. One new finding was the values of the lens equatorial diameters are actually longer than those reported previously. The results suggest that the values of the equatorial diameter measured by the loop device and those estimated by CASIA2® measurement were closer than those reported previously by other methods, although both were slightly different. We conclude that it is still difficult to estimate the equatorial diameter of the living human lens using preoperative examination parameters. This research will greatly contribute to the development of accommodative intraocular lenses in the future.

Characterisation and Modelling of an Artificial Lens Capsule Mimicking Accommodation of Human Eyes

A synthetic material of silicone rubber was used to construct an artificial lens capsule (ALC) in order to replicate the biomechanical behaviour of human lens capsule. The silicone rubber was characterised by monotonic and cyclic mechanical tests to reveal its hyper-elastic behaviour under uniaxial tension and simple shear as well as the rate independence. A hyper-elastic constitutive model was calibrated by the testing data and incorporated into finite element analysis (FEA). An experimental setup to simulate eye focusing (accommodation) of ALC was performed to validate the FEA model by evaluating the shape change and reaction force. The characterisation and modelling approach provided an insight into the intrinsic behaviour of materials, addressing the inflating pressure and effective stretch of ALC under the focusing process. The proposed methodology offers a virtual testing environment mimicking human capsules for the variability of dimension and stiffness, which will facilitate the verification of new ophthalmic prototype such as accommodating intraocular lenses (AIOLs).

An Artificial Lens Capsule with a Lens Radial Stretching System Mimicking Dynamic Eye Focusing.

Presbyopia is a common eye disorder among aged people which is attributed to the loss of accommodation of the crystalline lens due to the increasing stiffness. One of the potential techniques to correct presbyopia involves removing the lens substance inside the capsule and replacing it with an artificial lens. The development of such devices, e.g., accommodating intraocular lenses (AIOLs), relies on the understanding of the biomechanical behaviour of the lens capsule and the essential design verification ex vivo. To mimic the eye’s dynamic focusing ability (accommodation), an artificial lens capsule (ALC), from silicone rubber accompanied by a lens radial stretching system (LRSS) was developed. The ALC was manufactured to offer a dimension and deforming behaviour replicating the human lens capsule. The LRSS was calibrated to provide a radial stretch simulating the change of diameter of capsules during accommodating process. The biomechanical function of the ALC was addressed by studying its evolution behaviour and reaction force under multiaxial stretch from the LRSS. The study highlighted the convenience of this application by performing preliminary tests on prototypes of ophthalmic devices (e.g., AIOLs) to restore accommodation.

Retinal image quality with multifocal, EDoF, and accommodative intraocular lenses as studied by pyramidal aberrometry

BackgroundTo study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer.MethodsThis study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group); (b) 19 Miniwell; (c) 24 LENTIS Mplus LS-313 MF30; d) 33 LENTIS Mplus LS-313 MF15; (e) 17 AkkoLens Lumina; (f) 31 AT LISA Tri 839MP; (g) 20 Precizon Presbyopic; (h) 20 AcrySof IQ PanOptix; (i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer.ResultsAT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10; P < 0.05), followed by SA60AT (0.41 ± 0.11 and 0.28 ± 0.07) and PanOptix (0.4 ± 0.07 and 0.26 ± 0.04). AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.004). Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.002). Total RMS, LOA RMS, HOA RMS, PSF Strehl ratio and PSFw2 varied significantly between the studied groups (P < 0.001).ConclusionsFar distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens. AT LISA Tri, SA60AT and PanOptix showed the highest values of far distance retinal image quality, while the lowest PSFw2 Strehl ratios were displayed by Miniwell, Mplus MF30 and Precizon Presbyopic.

Citation network analysis of the various types of multifocal intraocular lenses.

The implantation of multifocal intraocular lens (IOL) has increased in recent years, allowing patients to achieve good quality vision at all distances, independence from use of glasses, and consequently, an increase in quality of life. The main purpose of this study was to analyse the links between publications and authors via citation networks, as well to as identify the different research areas and determine the most cited publications. The publication search was performed through the Web of Science database, using the terms «Multifocal intraocular lens», «Bifocal intraocular lens», «Trifocal intraocular lens», «Diffractive intraocular lens», «Refractive intraocular lens», «Accommodative intraocular lens» and «Extended depth of focus intraocular lens», for a time interval from 1989 to August 2020. The software used to analyse the publications was the Citation Network Explorer. A total of 1293 publications were found, with 11,730 citations generated in the network, and 2019 had the highest number of publications of any year. The most cited publication was «European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens» by Kohnen et al., published in 2006. Four groups about different research areas in this field were found using the Clustering functionality: visual quality, IOL designs, ocular aberrations, or defocus curves. The citation network offers an objective and comprehensive analysis of the main articles on the different designs and classes of multifocal IOL.

Future Intraocular Lens Technologies

The future of intraocular lens (IOL) technology has already begun with a number of recent innovations. The postoperative change of refractive power will lead to a customized fine-tuning that provides patients with the individual vision they expect and with as much spectacle independence as possible. The latest-generation (2.0) Light-Adjustable Lens (RxSight) was recently introduced into clinical practice, with the first results being very encouraging. Other methods of altering the power of an already implanted IOL are under development. The same can be said about the correction of presbyopia, the so-called last frontier in refractive surgery. Extended depth-of-focus IOLs have been introduced, as has the technology of the pinhole IOL. The latter has therapeutic potential beyond the refractive aspect and has already proven helpful in cases of iris defects and irregular corneas. Several technologies are currently being tested to achieve-finally-an accommodative IOL. One such concept uses the (remaining) strength of the ciliary muscle, whereas another is triggered by the pupil reaction when shifting focus from far to near. Not an IOL itself, but rather a high-tech innovation that so far has mostly been implanted during cataract surgery, is a microelectronic sensor that measures habitual intraocular pressure (IOP) at any given time and promises to revolutionize the management of glaucoma patients. The last generation of this device (Eyemate; Implandata Opthalmics Products GmbH) is implanted during small-incision cataract surgery; the latest development is an even smaller sensor that will be inserted suprachoroidally before, in the near future, such adevice will be part of a capsular ring. These IOP sensors are a prime example that IOL technology will continueto be a driving force in ophthalmology, with a positive impact far beyond cataract surgery.

Advances in the Study of Lens Refilling.

The ultimate goal of cataract surgery is to restore the accommodation while restoring distance visual acuity. Different kinds of accommodative intraocular lens (IOLs) and surgical techniques have been suggested to apply during the surgery, but they showed poor postoperative accommodation. It is possible to achieve this goal by refilling the lens with an injectable polymer. We present a summary of the existing materials, methods, results, and some obstacles in clinical application that remain of lens refilling for restoration of accommodation. Two main problems have restricted the clinical application of this technique. One was the formation of postoperative secondary capsule opacification and the other was the different accommodative power after surgery.

Intraoperative wavefront aberrometry to determine planar endpoint for the repositioning of vaulted accommodative IOLs.

Accommodative intraocular lenses (IOLs) are suitable options for patients desiring less dependence on spectacles after cataract surgery. Accommodative IOLs do not require diffractive optics and, therefore, might be used in a wider range of patients who have mild comorbidities or wish to avoid photopsia associated with diffractive IOLs. However, a small percentage of patients have experienced vault, or capsular contraction syndrome (CCS), due to fibroblastic metaplasia of lens epithelial cells. Early detection of CCS might be managed with Nd:YAG capsulotomy; however, accommodative IOLs with significant CCS have required viscodissection of the fibrosis and placement of a capsular tension ring. A challenge with this maneuver is using the operating microscope to determine whether the accommodative IOL has returned to planar position. This article describes a new technique using serial intraoperative wavefront aberrometry measurements of lenticular astigmatism during accommodative IOL repositioning to determine a planar endpoint in the reduction of vault.

2D Titanium Carbide (Ti3C2Tx) in Accommodating Intraocular Lens Design

AbstractWhile intraocular lenses (IOL) are used to restore visual acuity in cataract patients, they are limited in their development as no clinically available lens can effectively mimic the accommodative function of the eye's natural lens. The optoelectronic properties of 2D transition metal carbides and/or nitrides (MXenes), including high electronic conductivity, optical transparency, flexibility, biocompatibility, and hydrophilicity, suggest potential use within an accommodating IOL. This study investigates the use of Ti3C2Tx (MXene) as a transparent, conductive electrode to allow changes in optical power. Ti3C2Tx is synthesized and spin‐coated on hydrophobic acrylate IOLs, achieving a sheet resistance ranging from 0.2–1.0 kΩ sq−1 with 50–80% transmittance in the visible region. Human lens epithelial and monocytic cells show no cytotoxic nor inflammatory response to the coated lenses. An adjustable focus test cell is fabricated using a liquid crystal (LC) layer sandwiched between Ti3C2Tx coatings on a solid support. Molecular reorientation of the LC layer, through an applied electric field, results in changes in optical power as objects viewed through the test cell appeared in and out of focus. This study is the first step toward the use of Ti3C2Tx within an accommodative IOL design through demonstration of reversible, controlled, adjustable focus.

Accommodative intraocular lens concepts

AbstractThe restoration of accommodation still remains the biggest challenge of cataract surgery. The desire for real pseudophakic accommodation remains unchanged although modern multifocal lenses provide acceptable presbyopic correction and visual quality. Numerous concepts for accommodative intraocular lenses have been presented during the last decades but none of these were as successful as multifocal lenses are today. These concepts can be divided into three principles: Optic shift moves a single lens or a set of lenses along the optical axis such as the, for example, the 1CU (HumanOptics), the Crystalens (Bausch &amp; Lomb) and the Synchrony (Visiogen/AMO). Varying radius of curvature changes refraction oft he lens such as, for example, the Juvene (LensGen). Replacement of the or refilling of the capular bag remains an interesting option but refilling has not reached the stage of human clinical trials. We will present an overview on the various concepts for the restoration of accommodation in the pseudophakic eye and the current clinical status.

The AkkoLens Lumina accommodative intraocular lens

AbstractThe AkkoLens Lumina is an accommodative intraocular lens based on cubic, Alvarez, optical elements. The Lumina is designed to be implanted into the ciliary plane with the Lumina customized for the individual eye with each eye having its specific combination of refraction and sizing. The lens provides up to 4D of accommodation and provides a visual acuity and contrast sensitivity similar to a monofocal lens. The current state of development of the Lumina and clinical results are presented.