EyeWorld Asia-Pacific June 2021 Issue

CATARACT 18 EWAP JUNE 2021 by Liz Hillman Editorial Co-Director Contact information Cummings: abc@wellingtoneyeclinic.com Donnenfeld: ericdonnenfeld@gmail.com Garg: gargs@hs.uci.edu McCabe: cmccabe13@hotmail.com Vukich: javukich@gmail.com This article originally appeared in the March 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. What’s new in the world of IOLs N ew optical qualities, new materials, preloaded inserters, and the possibility of accommodative abilities: There has been quite a bit of movement in IOL innovations, some of which are available in the U.S., while others are still on the horizon. New optics While there has been a push toward presbyopia correction with IOLs, more recently quality of vision at distance has come into focus, said Cathleen McCabe, MD. “There’s been a trend with low-add multifocals, getting away from the original concept that if we were going to offer a premium service that it had to be great near and that it was OK to sacrifice quality of vision at distance or to accept unwanted visual disturbances,” she said, adding, “What we see now is that the quality of some of the offerings we have to extend the range of vision has improved to such a level that they may seriously compete with a monofocal lens for a wider variety of patients.” One such lens is the AcrySof IQ Vivity (Alcon). Vivity was FDA approved in February 2020 and began a commercial rollout later in the year. Vivity is a non-diffractive lens offering extended range of vision with, according to the company and anecdotal reports from physicians who have implanted it, a low incidence of visual disturbances. Dr. McCabe was involved in the FDA trials for Vivity and has used it since its commercial launch. She said this lens design gives her more confidence that she will have a happy patient postop. She has found it allows her to extend presbyopia correction as an option to more cataract patients than she previously would have. “For me, it’s the peace of mind knowing that if I put a Vivity lens in, my risk of having that patient complain about glare, halos, or starbursts is the same as if I put a monofocal lens in. I’m not worried that in the future the patient will come in and I’ll think to myself ‘I wish I hadn’t put this technology in,’” she said. It’s also been helpful in her consideration of patients who tend to be more exacting about their quality of vision or those who are on the fence in terms of eye health. “The increased comfort level of the decision making is one of the biggest things with Vivity. When they’re paying extra, patients expect to have an extended range of vision and have independence from their glasses, and they expect to not have visual disturbances. Patients are thrilled because the postop experience is what they expected anyway. Surgeons are thrilled that they did not have to do all those additional mental risk-benefit calculations preoperatively so that their patients could receive those benefits,” she said. Arthur Cummings, MD, who has had experience with Vivity since January 2020, said that the lens is uniquely forgiving. “Even if the lens is decentered significantly, you’re not going to get glare and halo, and even if you’re off target up to –1 in one eye, you’re not going to get glare and halo,” Dr. Cummings said, explaining that –0.5 to –0.75 of anisometropia seems to further extend depth of focus ability and functional near vision for the patient. Dr. Cummings thinks the forgiving nature of this lens will encourage more ophthalmologists who previously shied away from the presbyopia- correcting lens market to enter. “This lens will help grow the market,” he said. “People who never before considered themselves to be refractive cataract surgeons are going to start using it.” Other lenses not yet available in the U.S. are the Tecnis Synergy (Johnson & Johnson Vision) and LuxSmart (Bausch + Lomb). Synergy (currently available in Europe, Australia, New Zealand, and Canada) is described as a continuous