EyeWorld Asia-Pacific June 2021 Issue

CATARACT 22 EWAP JUNE 2021 vision, optical quality, and ease of use, the physicians interviewed for this article emphasized that tailoring IOL decisions to patient needs and setting appropriate expectations will continue to be important. “We’re going to have more in-depth conversations with patients and do more thorough preop evaluations, looking for patients who are good candidates and evaluate the distances achievable with these lenses,” Dr. Donnenfeld said. “I think that with all these options, we need to determine which patient parameters are best for these lenses and consider demands for quality of vision versus quantity.” “At the end of the day, it still comes down to picking the right technology for your patient and making sure they understand there is no perfect lens, and every lens has a positive and a drawback and that you discuss that with them,” Dr. Garg said. “Do I hope we’ll have a perfect lens for all patients one day? I do. Do I think we’ll ever actually get there? I don’t. I think we’ll still need to make sure we’re picking the appropriate technology for the patient.” EWAP Editors’ note: Dr. Cummings practices at Wellington Eye Clinic, Dublin, Ireland, and has interests with Alcon, RxSight, and Vivior. Dr. Donenfeld practices with the Ophthalmic Consultants of Long Island, Garden City, New York, and Johnson & Johnson Vision announced FDA approval and subsequent commercial launch of the TECNIS Eyhance and TECNIS Eyhance Toric IOLs in early February. These next generation monofocal IOLs are said to provide good distance vision and offer some patients extended intermediate and near vision. Douglas Koch, MD, implanted the first Eyhance IOLs outside of the clinical trial in the U.S. and shared his thoughts and experience thus far. “[These IOLs are] exciting because they give superb quality of distance vision with no increased glare, and they provide patients, on average, with an additional line of intermediate and near vision,” Dr. Koch said. When he spoke with EyeWorld , he had just implanted four Eyhance IOLs. Three of his patients were targeted for distance; on postop day 1, uncorrected acuities were 20/20, J2 intermediate for two and 20/25 J5 intermediate for the third. The fourth patient was targeted for –0.75 and was 20/30 and J2 near on postop day 1. These results, Dr. Koch said, “are consistent with what we know about this lens from the optical bench data and the feedback from our European colleagues—that it truly expands the depth of focus.” One study Dr. Koch thought was particularly powerful was by Auffarth et al., who reported that significantly more Eyhance patients had no difficulty with seeing to walk on uneven surfaces compared to monofocal controls (ZCB00, Johnson & Johnson Vision). 1 “With standard monofocal IOLs, some patients targeted for distance can see their cellphone and computer. Eyhance will increase Experience with a new next generation monofocal IOL this number significantly,” Dr. Koch said. He also highlighted the larger landing zone with this IOL. “We may find a higher percentage of patients hit 20/20 or 20/25 uncorrected for distance as well. There is about a half diopter landing zone, which is larger than with standard monofocal designs,” Dr. Koch said. How does Eyhance achieve these outcomes? Dr. Koch said the lens has a continuous aspheric surface for gradual steepening in the center without specific zones. Dr. Koch said that IOL calculations with this lens are the same, with the same A constant as the ZCB00. When it comes to aiming for a lens that goes to –0.4 D or –0.1, he said he would pick the latter more frequently with Eyhance. Dr. Koch doesn’t see any conditions as contraindications with this lens. “I am going to be comfortable implanting this in my patients with ocular pathology because the quality of vision is superb. There isn’t the compromise of dividing the light as you would see with any of the extended depth of focus or multifocal/trifocal designs,” he said. Eyhance is billed as a monofocal lens, which means it doesn’t cost the patient out of pocket, Dr. Koch said. EWAP Reference 1. Auffarth G, et al. Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract. J Cataract Refract Surg. 2021;47:184–191. Editors’ note: Dr. Koch has relevant interests with Alcon, Carl Zeiss Meditec, and Johnson & Johnson Vision. Contact Koch: dkoch@bcm.edu has interests with Alcon, BVI, Johnson & Johnson Vision, and LensGen. Dr. Garg practices at the Gavin Herbert Eye Institute, University of California, Irvine, California, and has interests with Alcon, Johnson & Johnson Vision, and LensGen. Dr. McCabe practices with The Eye Associates, Sarasota, Florida, and has interests with Alcon, Bausch + Lomb, Carl Zeiss Meditec, and Johnson & Johnson Vision. Dr. Vukich practices at SSM Health Davis Duehr Dean Eye Care, Madison, Wisconsin, and has interests with AcuFocus and Johnson & Johnson Vision.