EyeWorld Asia-Pacific June 2018 issue

September 2017 3 EWAP EDITORIAL June 8 EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Hiroko BISSEN-MIYAJIMA, Japan Hungwon TCHAH, South Korea ASIA-PACIFIC CHINA EDITION Regional Managing Editor YAO Ke Deputy Regional Editors HE Shouzhi ZHAO Jialiang Assistant Editors SHENTU Xing-chao ZHOU Qi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN Deputy Regional Editor Abhay VASAVADA ASIA-PACIFIC KOREA EDITION Regional Managing Editor Hungwon TCHAH Deputy Regional Editor Chul Young CHOI John CHANG, Hong Kong Johan HUTAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Ronald YEOH, Singapore S. NATARAJAN, India Sri GANESH, India YAO Ke, China Y.C. LEE, Malaysia ENLIGHTENMENT Graham Barrett Chief Medical Editorial EyeWorld Asia-Pacific W hen I began my career in ophthalmology the choice of a posterior chamber intraocular lens (IOL) was limited to a polymethylmethacrylate (PMMA) optic with different styles of either PMMA or polypropylene open loop haptics. Recognizing these limitations, I developed a hydrophilic acrylic intraocular lens which offered improved biocompatibilty and being foldable for small incision cataract surgery. Today there are several foldable materials available for IOLs and these can be broadly classified into hydrophilic acrylic, hydrophobic acrylic, and silicone materials. Each material has its own advantages—hydrophilic acrylics are extremely biocompatible but there is potential for calcification, particularly when combined with air fluid gas exchange, silicone has a similar caution when used with VR procedures, particularly with silicone oil, and currently hydrophobic acrylic material are the most popular. Concerns with long-term glistening formation that has been noted with hydrophobic acrylic materials have been addressed and the major manufacturers such as Johnson and Johnson, Bausch and Lomb, and more recently Alcon offer hydrophobic acrylic materials with minimal potential for this phenomenon. There is always a trade-off of an optic with a higher refractive index which allows a smaller incision with a full-sized optic compared to lower refractive index materials which require either a larger incision or a reduced optic size depending on the lens power. There are subtle differences in haptic design and stability. Rotational stability is particularly important with toric IOLs and has been shown to differ among the different platforms that are available. In addition, the ability to predict an accurate outcome varies with different optic and haptic designs which also influences one’s choice of a preferred intraocular lens. Finally, in addition to the lens model itself, the delivery platforms have also evolved. Preloaded systems are now available from most companies. This avoids handling the lens and facilitates insertion without exposure to the exterior of the incision. Some of the more sophisticated delivery devices are automated, which allows more control and consistent insertion. Monofocal IOLs do provide the highest quality vision but additional functionality is available to address presbyopia with multifocal as well as extended depth of focus IOLs. We are indeed fortunate to have available a variety of intraocular lenses from which we can select the lens we feel offers the best balance of features that we as individual surgeons find important for our patients. I hope the discussions of the various IOL materials and designs contained in this issue helps clarify some of the properties and features that need to be considered. I’m sure that this area will continue to evolve and we can look forward to a future with intraocular lenses that provide perfect clarity, excellent biocompatibility, and predictable spherical and astigmatic refractive outcomes. EWAP “ We are indeed fortunate to have available a variety of in- traocular lenses from which we can select the lens we feel offers the best balance of features that we as individual surgeons find important for our patients. ” –Graham Barrett, MD