EyeWorld Asia-Pacific September 2016 Issue

EWAP SECONDARY FEATURE 41 September 2016 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer ‘Quality of vision rules’ everything presbyopia F or the first session of the scientific program of the 29th APACRS annual meeting, experts from the APACRS, the American Society of Cataract and Refractive Surgery (ASCRS), and the European Society of Cataract and Refractive Surgeons (ESCRS) came together for the Combined Symposium of Cataract and Refractive Societies (CSCRS). The CSCRS—this year chaired by Graham Barrett, MD , Perth, Australia, Kerry Solomon, MD , Mount Pleasant, S.C., U.S., and Oliver Findl, MD , Vienna, Austria—is intended “to provide an academic forum for the different regional societies to present the very best of those societies on a specific theme,” said Dr. Barrett. The symposium is held at each of the participating society’s respective annual meetings and is the plenary session of this year’s APACRS annual meeting. “We give it the prominence we think it deserves,” Dr. Barrett said. This year, the CSCRS sought to provide a comprehensive overview of the wide range of presbyopia variations, he added, has come from playing with the distance between each step. While diffractive bifocal IOLs achieve two focus points, Dr. Cionni said that many actually achieve a plateau, providing a good range of vision. However, while they provide very good distance and very good near, “in all you lose some light, 10–20% to scatter.” This results in a decrease in contrast sensitivity. Positive dysphotopsias are also a sequela, and limited vision beyond the sharp focus points, with some IOLs having more limitations than others. These IOLs are sensitive to visual imperfections, and an acclimation period may be required. Recent advances in multifocal IOLs include aspheric optics, lower add models that provide higher patient satisfaction and less compromise. Despite all the limitations, these lenses, he said, “do tend to give better distance and better near than trifocals—so there is a role in terms of vision.” Nevertheless, of his patients who want multifocals, Dr. Cionni said only one third are good candidates. Following Dr. Cionni’s talk, Dr. Nuijts agreed that multifocals provide an opportunity to make patients more spectacle independent after cataract surgery—with increased immediate visual acuity without compromising distance and near. Trifocals, however, he said, provides better performance than bifocal diffractive IOLs. Dr. Nuijts described three trifocal IOLs: The FineVision MicroF Trifocal IOL (Physiol, Liège, Belgium), which combines two apodized diffractive profiles on the anterior surface, making light distribution dependent on pupil size; AT LISA tri 839MP (Carl Zeiss Meditec, Jena, Germany), which has a central trifocal zone and peripheral bifocal zone; the PanOptix Trifocal (Alcon, Fort Worth, Texas), with its non- apodized trifocal design that makes light distribution less dependent on pupil size. Trifocals, he said, have larger diffractive zones than classic multifocals. Dr. Nuijts also presented the results of a PanOptix pilot study compared with those of a randomized controlled trial comparing the FineVision IOL with the ReSTOR +3.0 D. The PanOptix pilot found good results 3 months after implantation, with uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity after 3 months better in the PanOptix group compared to other multifocal IOLs after 6 months. All groups provided 0.2 solutions currently available with the theme “All I Want is Everything.” “We want it all,” Dr. Barrett said. “The question is can we deliver?” Bi/tri multifocal IOLs continued on page 42 CSCRS chairs Dr. Barrett (center), Dr. Solomon (left), and Dr. Findl. Source: APACRS Robert J. Cionni, MD , Salt Lake City, U.S., and Rudy Nuijts, MD , Maastricht, Netherlands considered bifocal and trifocal lenses, respectively. Dr. Cionni has had a long history of working with bifocal IOLs, from the earliest versions in the 1990s, such as the 3M diffractive multifocal IOL. “Since that point in time we’ve had a large variety,” he said. The mechanism of action he said, has remained essentially the same: a diffractive gradient based on the Fresnel prism—“steps” on the IOL surface. A lot of