EyeWorld India June 2017 Issue

EWAP refractive 41 June 2017 Era of multifocality by Michelle Stephenson EyeWorld Contributing Writer New adds offer new options P revious generations of multifocal IOLs (high add power) provided good quality near vision for reading. However, intermediate and distance vision were not optimal, and many patients reported issues with glare and halos with these lenses. Recently, there has been a shift in patient preferences, with an increasing number of patients preferring intermediate distance for reading. This has occurred because, unlike previous generations, today’s patients read at mid-range distances because most reading is done on computers and smart phones. Patients are finding that their world now revolves around mid-range distances. “In the past, people read things very close up, and the earlier IOLs had very close reading adds that provided good reading vision. However, they really weren’t suitable for computer vision at mid-range, and patients tended to have a small blank area in the mid-range that affected their ability to do many tasks,” said Eric Donnenfeld, MD , Rockville Centre, New York. Concurrent with the shift in patient preference, new low add multifocal IOLs, which have stronger intermediate vision performance and seem to have less nighttime symptomatology, have entered the marketplace. “Fortunately, the advent of these low add multifocal IOLs times very well with the shift in the market preferences with a higher percentage of patients expressing a greater desire for intermediate performance and less concern for up-close book reading. The higher patient satisfaction rates we are seeing with these lower add multifocal lenses is invigorating the market. The three newer additions that we have are the ReSTOR 2.5 [Alcon, Fort Worth, Texas], the Tecnis 2.75 [Abbott Medical Optics, AMO, Abbott Park, Illinois], and the Symfony lens [AMO],” said Gary Foster, MD , Fort Collins, Colorado. He noted that the ReSTOR 2.5 has a higher percentage of light energy directed to the distance image, so it is the most distance- dominant of any of the multifocal lenses. “I view this lens as having the best distance performance with the fewest night symptoms, and it has acceptable intermediate performance. I view the Tecnis 2.75 as having the strongest intermediate performance of any of the available multifocal lenses, but it has a bit more nighttime symptomatology and less light dedicated to distance vision than the ReSTOR 2.5. I tend to use this lens in people with very high precision intermediate needs. The Symfony has an extended range of focus and accounts for chromic aberrations, which allows a nice range of intermediate vision for patients. It also has a toric option available, which broadens its appeal, and a very high level of patient satisfaction and acceptance,” Dr. Foster said. For patients who desire near reading performance and have a less strong desire for intermediate performance, higher add multifocal lenses like the ReSTOR 3.0 or the Tecnis 4.0 are the two main choices. “For most patients with a near reading requirement, I prefer the ReSTOR 3.0 because I believe there are fewer issues with nighttime glare and halos, and it has a little bit better intermediate performance. I tend to use the Tecnis 4.0 for patients with short arms that therefore need strong reading performance and closer than normal reading distances,” Dr. Foster added. Patient selection Dr. Donnenfeld said that the IOL chosen for each patient is predicated on the patient’s visual needs and his or her demand for quality vision at distance. “When The Symfony extended depth of focus IOL with diffractive rings Source: Eric Donnenfeld, MD The Symfony extended depth of focus IOL offers an additional technology for presbyopia correction. Here, the IOL’s centration is confirmed by the Callisto (Zeiss) overlay. Source: Bryan Lee, MD continued on page 42