EyeWorld Asia-Pacific June 2016 Issue

41 EWAP CATARACT/IOL June 2016 repartition of energy between far and near vision. “The higher the steps, the higher the energy,” he said. “Too much energy, however, will cause halos and glare.” The FineVision lens, for example, is designed such that it contains higher power in the center of the lens to avoid night vision problems. However, the One of the newer presbyopia- correcting IOLs is the Acriva Reviol Trifocal (VSY Biotechnology, Amsterdam), which combines numerous mechanisms and includes features such as chromatic aberration control, photoprotection, a square edge, a diffractive trifocal pattern, extended depth of focus, and pupil independence, and makes the majority of patients free of glasses, Dr. Daya said, citing data from the manufacturer. Another newer IOL designed to treat presbyopia is the NuLens (NuLens, Herzliya Pituach, Israel), which reportedly provides accommodation of 6–8 D. Still another new IOL is the FluidVision IOL (PowerVision, Belmont, Calif.), which features a fluid reservoir where fluid moves back and forth through a pliable system. With any lens, Dr. Daya stressed that there is a period of adaptation, so lenses should generally not be removed too soon after being implanted even if patients report some negative feedback. “Patients learn to adapt, and that usually takes 3 months and in some cases longer. They often need a lot of support,” he said. If there is any likelihood of lenses being explanted, Dr. Daya suggested avoiding laser capsulotomy. EWAP Editors’ note: Dr. Daya has financial interests with Abbott Medical Optics, Bausch + Lomb (Bridgewater, NJ), Carl Zeiss Meditec, Medicem, and NIDEK. Contact information Daya: sdaya@centreforsight.com Views from Asia-Paci c Hiroko BISSEN-MIYAJIMA, MD, PhD Tokyo Dental College Suidobashi Hospital 2-9-18 Misaki-cho, Chiyoda-ku, Tokyo, Japan 101-0061 Tel./Fax no. +81-3-5275-1912 bissen@tdc.ac.jp I believe presbyopia-correcting IOLs are moving forward by reviewing the drawbacks of the existing IOLs and improving their technologies. It is amazing that the basic concept of current presbyopia IOLs was developed more than 30 years ago. The “new generation of IOLs” mentioned in this article would be considered the third generation. Most of us remember that “the new generation multifocal IOLs” was one of the hot topics around early 2000, and I would say that those IOLs were the second generation. At the time of the rst generation, the IOL was not foldable, required a larger incision, the biometry was not accurate, and corneal astigmatism was not a major issue. When the Tecnis multifocal and ReSTOR, which would be categorized as the second generation, came to the market, we were impressed by better uncorrected visual acuities at distance and near. Those IOLs could be implanted through a smaller incision which provides a method to reduce preoperative corneal astigmatism. However, the typical drawbacks of the diffractive design, such as loss of contrast sensitivity and night vision, remained. As the author described in this article, surgeons would like to retain the preferable visual acuities from near to distance, and reduce the drawbacks of the multifocal IOL. As for the diffractive design, an IOL with lower near addition was developed. Also, the trifocal design has become popular. If the eye with trifocal IOL achieves similar visual acuities at distance and near and better visual acuity at intermediate distance compared to that of the bifocal IOL, most surgeons would prefer to implant the trifocal IOL. The new IOL which has the design to elongate the focus and maintain good contrast sensitivity would be suitable for the patient who requires good quality of vision. The newer IOLs such as NuLens and Fluid Vision have the potential to be the fourth generation. Until a true accommodating IOL is developed, none of these IOLs are the perfect solution for presbyopia. However, the new generation IOLs are coming close to the quality that ophthalmologists themselves can accept for their own eyes. Editors’ note: Dr. Bissen-Miyajima is a consultant for Abbott Medical Optics. compromise is pupil dependency for reading, so patients may have to turn the lights up to read. With the same step height over the whole optic surface, there is the same energy proportion between far/near, regardless of the pupil aperture. “Such a lens is pupil independent,” Dr. Daya said. Appropriate diagnostic tools are vital in managing astigmatism that can accompany refractive error and must be corrected in order to obtain maximum performance from premium lenses. For toric lenses, newer models of the I/L-aster #arl :eiss -editec such as the IOLMaster 500 and 700 as well as the NIDEK ALScan (NIDEK, Fremont, Calif.) can be employed. “Don’t use older versions of the IOLMaster to determine the axis of the lens,” he said. “They are not good for accurately determining the axis of astigmatism. There is a higher likelihood of incorrect orientation, and as a consequence, correction will be underpowered. Corneal topography is very important in determining the magnitude and axis of correction.” The Symfony IOL (Abbott Medical Optics) features an echelette design to elongate IOL focus and achromatic technology to correct chromatic aberration and improve contrast. According to data from the manufacturer, the IOL has been found to produce uncorrected binocular visual acuity of 20/25 or greater for far and intermediate vision in more than 90% of patients who received these IOLs. The same percentage achieved 20/40 uncorrected visual acuity for near vision. When patients were asked about their dependence on spectacles, the majority (97%) said they were satisfied with their daytime vision without glasses, and 84% said they were satisfied with their night vision without glasses. Mild to moderate halos and glare were reported in 22%, and some patients complained of poor visual quality.