EyeWorld Asia-Pacific June 2015 Issue

June 2015 19 EWAP FEATURE Views from Asia-Paci c Hungwon TCHAH, MD Asan Medical Center, University of Ulsan 388-1 Pungnab-dong, Songpa-gu, Seoul, South Korea Fax no. +82-2-4706440 hwtchah@amc.seoul.kr N owadays, cataract patients have the choice of “premium multifocal IOLs” that can correct vision near as well as far. I think that the results of these IOLs are within the acceptable range because patient satisfaction rate is reported around 85–95%, of course not 100%, depending on researchers. There also has been improvement in these IOLs to decrease side effects, such as decreased contrast sensitivity, waxy vision, glare and halo, and to increase visual quality. As a result, trifocal IOLs, apodized IOLs, various aspheric IOLs and low add IOLs were introduced with some success. Now we have new IOls, the so-called “extended depth of focus IOLs,” which were designed to provide clear far and intermediate vision in exchange of some sacri ce of near vision. It has been my experience that one of the main reasons for dissatisfaction with multifocal IOLs was not inadequate near vision but poor quality of far vision. So, if visual quality of far vision is improved with these new IOLs which seems to be possible, patient satisfaction rate will increase. But, the point is that patients may have to pay as much as they pay for multifocal IOLs and may still need reading glasses. How do we explain this to our patients? One of the solutions will be a price cut from industry, which seems to be dif cult in near future. Interestingly enough, I nd that there are many patients who do not mind wearing reading glasses in prolonged reading after so-called premium surgery with extra cost on the conditions that they have good far vision and can read small text without reading glasses in casual daily life such as text messages in cell phones or price tags. From Dr. Goes’s and my limited experiences, those conditions may be ful lled with or without slight mini monovision in bilateral cases because of good intermediate vision There are not enough resources to evaluate extended depth of focus IOLs completely. A longer term follow up study of a large group will be needed for more detailed evaluation of this IOL. Nontheless, I, as a doctor, am pleased to have these new IOLs because I always want to have more options to make the patients happy. Editors’ note: Dr. Tchah declared no relevant nancial interests. John S.M. CHANG, MD Director, Guy Hugh Chan Refractive Surgery Centre Hong Kong Sanatorium and Hosptial 8/F Li Shu Pui Block, Phase II 2 Village Road, Happy Valley, Hong Kong Tel. no. +852-2835-8885 Fax no. +852-2835-8887 johnchang@hksh.com O ne of the disadvantages of traditional bifocal/trifocal IOLs is that they only have two or three xed focal points where patients can see clearly. Anywhere between these focal points their vision is blurry so patients have to adjust with their positioning. Also, waxy vision and especially halo and glare are frequent complaints by the patients. European studies have shown that patients rarely complain of halo and glare. Our early experience (3 months) is in line with this ndings. None of our patients complained of this and when asked they would either not have any or report very mild halo. This can be explained by the ZXR having nine rings compared to the ZMB00 which has 22 rings. We implanted the Symfony in a cataract patient who works as a boat driver, who often drove boats at night in a dark environment. After surgery, he had hardly any halo, and he could see distance and his instrument panel very clearly at night. We tested our patients’ defocus curves and found that they truly have increased depth of focus with clear vision from distance to 60 cm. However, near is understandably weaker. In North America and North Europe where patients are taller and hold their reading materials further away, the ZXR along with micromonovision of “-0.50 to -0.75 D” should work very well. However, in Asia where we tend to have shorter arms, we usually hold our reading material and smartphones much closer (40 cm or even closer). Micromonovision may not be enough. Despite the “weaker” near vision, our experience is that patient satisfaction is quite high, all our patients were happy with their distance and near vision. With a more “forgiving” lens with less halo and glare, this lens may replace the monofocoal lens in the future. More studies are needed and we look forward to implanting more Symfony lenses. Editors’ note: Dr. Chang receives travel support from Abbott Medical Optics and Alcon Laboratories (Fort Worth, Texas). Ill.), the extended range of vision lens available for patients with or without astigmatism. Although the lens can be implanted unilaterally or bilaterally, the FDA trial is using bilateral implantation. Currently, extended depth of focus and the extended range of vision IOLs are used in Europe and around the world, Dr. Donnenfeld said. The FDA trials are in process, and it may be about a year and a half before the Symfony lens is approved in the U.S., he estimated. For more information about European results of this lens and how it differs from extended depth of focus technology, see “New lens solves problems of presbyopia- correcting IOLs” also in this issue of EyeWorld Asia-Pacific. Lenses that employ extended depth of focus technology include the Mplus (Oculentis, Berlin), Mini Well (Sifi MedTech, Aci Sant’Antonio, Italy), a lens in development from Hoya (Chino Hills, Calif.), and the IC-8 IOL (AcuFocus, Irvine, Calif.). Glare, halos, contrast sensitivity One advantage seen so far with the technology of these lenses is that they do not have the same glare and halos associated with multifocal IOLs. “There is minimal glare and halo, equivalent to that with a monofocal lenses,” Dr. Donnenfeld said, citing data from an AMO Symfony study. There does appear to be some loss of contrast sensitivity, but this seems to bother patients less due to the lack of halos and glare, Dr. Donnenfeld said. “The Symfony lens that I work with has a chromatic aberration that compensates for contrast sensitivity, so patients don’t seem to see or feel a difference,” he said. There are emerging studies about extended depth of focus and extended range of vision IOLs compared with other IOL types. “Data presented at the 2014 European Society of Cataract & Refractive Surgeons meeting in London showed that the bilaterally implanted Tecnis monofocal exhibited 1.5 D of defocus and maintained 20/40 or better visual acuity, whereas the Tecnis Symfony showed 2.5 D and maintained 20/40 or better, approximately 1 D extended depth of focus,” Dr. Holladay said. continued on page 20