EyeWorld Asia-Pacific June 2018 issue

June 2018 18 EWAP FEATURE Finding a niche for extended depth of focus IOLs by Vanessa Caceres EyeWorld Contributing Writer AT A GLANCE • Extended depth of focus IOLs may provide patients with a more natural range of vision, but the near may not be as strong compared with a multifocal IOL. • The best candidates for EDOF IOLs have no coexisting ocular disease and have realistic expectations for the lenses. Patients should still expect to use glasses occasionally. • Surgeons have mixed opinions about using EDOF IOLs in patients with previous LASIK. • Mixing and matching EDOF IOLs and multifocal IOLs in patients is one approach to meeting their visual requirements. Considering visual needs, patient expectations C ataract surgeons con- tinue to find the right place to fit extended depth of focus IOLs (EDOF IOLs) within their toolbox. Currently, the only EDOF IOL available in the U.S. is the Symfony lens (Johnson & Johnson Vision, Santa Ana, California). The pros and cons of EDOF IOLs are best put into context by comparing them to other IOL types. When explaining EDOF IOLs to patients, Kendall Donaldson, MD , associate professor of oph- thalmology, and medical direc- tor, Bascom Palmer Eye Institute, Plantation, Florida, lets them know that these lenses provide a more natural range of vision. “As com- pared to a monofocal distance IOL, they would gain more intermedi- ate vision and some degree of near vision,” Dr. Donaldson said. “In contrast to a multifocal IOL, they would gain the intermediate/com- puter distance vision with EDOF IOLs.” “I tell patients who are in- terested in EDOF IOLs that the advantage of these lenses is that they provide excellent quality of vision as compared to multifocal IOLs. They also provide excel- lent mid-range vision,” said Eric Donnenfeld, MD , Ophthalmic Consultants of Long Island, Gar- den City, New York. “However, the disadvantage of EDOF IOLs is that they do not provide near vision that is as good as higher add multi- focal IOLs.” Finding the best candidates The best candidates for an EDOF IOL have no concomitant ocular disease, such as macular issues, moderate to advanced glaucoma, or moderate to advanced ocular sur- face disease, Dr. Donaldson said. “I also prefer not to use EDOF IOLs in patients with a history of prior corneal laser vision correc- tion to avoid induction of further visual disturbances in a patient with potential higher order aber- rations from their prior LASIK procedure,” she said. In contrast, Dr. Donnenfeld will use EDOF IOLs in patients with mildly irregular corneas such as following LASIK or radial kera- totomy. That’s because the lenses are more tolerant of residual hy- peropia and astigmatism, he said. Uday Devgan, MD , private practice, Devgan Eye Surgery, Los Angeles, and clinical professor of ophthalmology, Jules Stein Eye In- stitute, UCLA School of Medicine, Los Angeles, thinks ideal candi- dates for EDOF IOLs are those will- ing to tolerate night glare and halo in exchange for a modest improve- ment in range. Just as with other premium IOL types, there are certain candidates in whom it is best to avoid EDOF IOLs. “Patients who desire maxi- mum image quality and are willing to wear spectacles for near work should not be considered for an EDOF IOL,” Dr. Devgan said. “Poor candidates are those who have unrealistic expectations, are unable to tolerate the visual imperfections induced by the EDOF IOL, or those with concurrent ocular conditions that will prevent best optical per- formance.” Tecnis Symfony IOL Source: Uday Devgan, MD