EyeWorld China December 2019 Issue

ADVANCED TECHNOLOGY IOLs Advanced-technologyIOLsincludingasphericIOLs, toricIOLs,multifocal IOLsandaccommodativeIOLs have transformed cataract surgery into refractive surgery providing enhanced visual performance and optimizing refractive outcomes. The aspheric IOLs counteract the natural spherical aberration present in the human eye, while toric IOLs offer rotational stability and refractive predictability. As opposed to monofocal IOLs that provide one point of focus and result in either a good near vision or distance vision, advanced technology multifocal IOLs provide two or more points of focus and improve both near and distance vision promoting spectacle independence. Since intermediate vision is most important for performing daily tasks on computers and smartphones, trifocal IOLs that improve intermediate vision along with near and far vision play an important role in enhancing patient satisfaction. AcrySof ® PanOptix ® and PanOptix ® Toric IOLs Michael Lawless AcrySof ® IQPanOptix ® is a trifocal IOL designed to provide an enhanced visual performance with complete range of vision for near, intermediate, and far distances after cataract surgery, thus reducing spectacle dependence. AcrySof ® IQ PanOptix ® toric presbyopia and astigmatism-correcting IOL is intended for use in cataract surgery patients with pre-existing corneal astigmatism and allows cataract treatment and astigmatism correction in a single procedure. AcrySof ® PanOptix ® trifocal IOLs have been shown to provide better visual outcomes at near and intermediate distance vision compared to ZEISS AT LISA ® tri 839MP IOL at 6 months post-operatively. 1 AcrySof ® PanOptix ® trifocal IOLs have also demonstrated significant improvement in near, intermediate and distance visual acuity 12-months after cataract surgery. 2 A Japanese study that evaluated the effect of manifest refraction spherical equivalent error on visual acuity in eyes that received a trifocal IOL showed that slight myopia significantly improved near visual acuity but worsened distance visual acuity, whereas slight hyperopia worsened both distance and near visual acuity. Therefore, though emmetropia is the optimum target, slight myopia is a better target refraction than slight hyperopia in patients receiving trifocal IOLs. 3 Comparison of Pan-Optix ® (panfocal) and AT LISA ® (trifocal) IOL after femtosecond laser- assisted lens surgery showed that both Pan- Optix and At LISA ® IOLs provided excellent distance, intermediate, and near vision, high spectacle independence and high patient satisfaction. However, PanOptix ® was better for patients with intermediate vision requirements at 60 cm compared to trifocal At LISA ® IOL at 80 cm. 4 In order to derive the best possible benefit, identification of patients who are ideal candidates for trifocal IOLs is crucial. Though post- operative vision is not affected by angle kappa (κ), the quality of vision will be degraded with a trifocal lens if κ>0.5mm, and there will be more glares and halos if κ>0.4mm. Therefore, it is essential to assess the choice of trifocal IOLs in patients with larger angle kappa. 5 “I am cautious regarding trifocal IOLs in patients with a preoperative corneal coma >0.3 or total corneal higher order aberration (HOA)>0.5. (for a corneal diameter of 6mm) Some mechanism of looking in greater depth at the quality of visually relevant topography in the central 4 mm zone will help to decide patient suitability for trifocal IOLs” added Dr. Lawless “Since refractive target near plano with trifocal IOL is the optimal target, my benchmark is 9 out of 10 people should be on target within 0.5D of sphere and cylinder for enhancement rate and YAG capsulotomy rates to be reduced.” Dr. Michael Lawless Pan-Optix ® toric IOLs provide enhanced visual performance and optimized refractive outcomes with complete range of vision from near to intermediate to far distance promoting spectacle independence. Beginning with the AcrySof ® platform foundation, which was the first material used for IOLs, technological evolution and innovation has led to improvements in design, material and optics of IOLs. Clareon ® is a next generation advanced monofocal IOL made from hydroxyethyl methacrylate (HEMA), a hydrophobic acrylic, that helps the IOL to control its water content and offer unsurpassed optical clarity. Clareon ® AutonoMe ® is the first and only automated, disposable and preloaded IOL delivery system with comfortable ergonomic hand positions, speed control and full IOL visibility during delivery. SCIENCE AND TECHNOLOGY OF CLAREON ® AND CLAREON ® AUTONOME ® Cheong Fook Meng Gleneagles Kuala Lumpur Malaysia Ronald Yeoh Eye & Retina Surgeons Singapore David Lubeck Arbor Eye Care USA Lucien Angelen Global Strategist Digital health for Deloitte’s Center for the Edge The Netherlands Michael Lawless Vision Eye Institute Australia Abhay Vasavada Raghudeep Eye Hospital India