EyeWorld Asia-Pacific September 2021 Issue

REFRACTIVE 30 EWAP SEPTEMBER 2021 membrane, or other ocular issues that could interfere with quality of vision for a diffractive EDOF lens, he said he has a bit more latitude with Vivity, but he’s still cautious. “We have seen patients with severe night disturbances, even with Vivity. Generally, the best use of Symfony OptiBlue and Vivity is in eyes that are capable of high-quality vision. I think that the more the envelope is stretched, the less likely we are to make the patient happy,” he said. “I use the Eyhance more like a monofocal and would be comfortable offering it to anyone capable of good quality vision.” Dr. Sobti said he balances the goals of the patient with their risk tolerance in helping them decide on an IOL. In general, Dr. Sobti said most patients are candidates for Eyhance. “Patients with mild retinal disease or mild to moderate glaucoma would traditionally not be good candidates for multifocal IOLs. However, since the Eyhance does not significantly change contrast sensitivity and is more forgiving, U.S. FDA approved in March 2021, the RayOne EMV (Rayner) is described as a non-diffractive IOL that enables enhanced depth of field. Jerry Hu, MD, Texas Eye and Laser Center, Fort Worth, Texas, said his experience with the lens is admittedly in the early stages, but his overall impression thus far is positive. “The most obvious advantage of RayOne EMV is its innovative optic design that combines the benefits of both positiÛe and negative spherical aberration within a single platform. As we know, an IOL with positive spherical aberration can extend the depth of focus and induce a small myopic shift, whereas an IOL with negative spherical aberration offsets the positive spherical aberration of the cornea to improve quality of vision such as contrast sensitivity,” Dr. Hu said. “RayOne EMV incorporates positive spherical aberration in the central portion of the optics to increase the effective add power in a photopic environment, and it transitions to negative spherical aberration in the periphery to improve image quality and contrast sensitivity in mesopic conditions. The end result is monofocal image quality with added intermediate vision to the tune of +1.25 D.” Dr. Hu said he offers this lens to patients who desire spectacle independence but who are not necessarily good candidates for A look at the recently approved RayOne EMV multifocal IOLs, including those with mild corneal abnormalities, early dry AMD, well-controlled mild glaucoma, and previous history of refractive surgery. He said he would avoid offering the RayOne EMV to patients who already have higher positive spherical aberration than usual, such as those who have had myopic LASIK or PRK. When it comes to patient discussions, Dr. Hu said he doesn’t explicitly advertise the enhanced intermediate vision of the IOL because it is approved as a monofocal lens. He instead includes the RayOne EMV in some of his advanced surgical packages, such as those with femtosecond laser cataract surgery and intraoperative aberrometry. In a message to young eye surgeons, Dr. Hu said to “always be on the lookout for new technologies.” “Be willing to try new technologies on appropriate candidates but do so gradually and with caution,” he said. “The most important message is follow your outcomes closely. Make a spreadsheet of your first group of patients and fill in their £-month postop data when available. When you are convinced by these early personal data, you can hit the ground running and begin offering the new technology in mass.” Relevant disclosures Hu: None Contact Hu: jerryganghu@hotmail.com we could consider this,” he said. He’s found Eyhance especially useful for patients who want to have monovision or mini-monovision, with it providing a more natural result. Dr. Sobti said Eyhance seems to be more forgiving in helping meet the refractive goals of post-LASIK/RK patients in whom IOL calculations can be difficult. Dr. Lahners compared lenses to investing. High risk can equate to high reward, and conversely, lower risk can equate to lower reward. “The Symfony OptiBlue lens, being the most powerful, has the most potential for night symptoms, although with the new OptiBlue these have been very mild,” he said. “The Vivity fits in the middle both in terms of performance and night disturbances. The Eyhance is the closest to a classic monofocal with less near performance but near monofocal-like night vision.” EWAP Editors’ note: Dr. Lahners practices at Center for Sight, Sarasota, Florida, and has interests with Johnson & Johnson Vision. Dr. Sobti is in practice at Texas Eye and Cataract, Waxahachie, Texas, and disclosed no relevant financial interests.