EyeWorld India March 2020 Issue

FEATURE 8 EWAP MARCH 2020 U.S. ophthalmologists start to experience trifocal IOLs by Liz Hillman EyeWorld Editorial Co-Director AT A GLANCE • The first trifocal IOL to receive FDA approval was PanOptix (Alcon) in August 2019. The enVista trifocal IOL (Bausch + Lomb) is in clinical trials in the U.S. • Surgeons report positive patient experience with PanOptix thus far with good range of vision at near, intermediate, and distance. • They also report fewer dysphotopsias often associated with multifocal and extended depth of focus IOLs. • There are characteristics that should be taken into account when considering a patient as a candidate for a trifocal IOL. Contact information Cionni: rcionni@theeyeinstitute.com Donnenfeld: ericdonnenfeld@gmail.com Solomon: kds@cepmd.com Yeu: eyeulin@gmail.com This article originally appeared in the December 2019 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. F or years, ophthalmologists have been hearing about the success with trifocal IOLs from outside the U.S. With FDA approval of the AcrySof IQ PanOptix trifocal IOL (Alcon), U.S. ophthalmologists now are beginning to use this option, drawing confidence from experience reported overseas. “What I appreciate the most is that because of the span of time that has passed where there has been availability internationally, it really gives us the breadth of what the international experience has been like,” Elizabeth Yeu, MD, said. “Right now, the experience allows us to recognize that there is a reason this lens has taken over the market for multifocals overseas, where it has been a leader in the multifocal space. It gives me some greater confidence and trust that the lens technology works as it’s supposed to given the fuller range of vision. “It appears that there are less bothersome dysphotopsias and very high quality of vision, and those are all things we’re thinking about when we’re thinking about any light-splitting technologies: 1) quality of vision, 2) range of vision, and 3) unwanted side effects,” Dr. Yeu said. PanOptix is currently the only FDA-approved trifocal in the U.S. Bausch + Lomb is in the midst of a clinical trial with its enVista MX60EF trifocal IOL, enrolling its first patient for the 500-patient study in June 2018. Trifocals that are currently being used outside of the U.S., in addition to PanOptix, are the AT LISA (Carl Zeiss Meditec), FineVision (PhysIOL), and RayONE Trifocal (Rayner). Dr. Yeu, Robert Cionni, MD, and Kerry Solomon, MD, who were involved with the PanOptix clinical trial, and Eric Donnenfeld, MD, shared their thoughts and experience with this technology coming to the U.S. Significance of trifocals Dr. Donnenfeld said the availability of trifocal lenses in the U.S. is important because it offers a different type of vision, a different option to patients. “What we have in the U.S. are wonderful lenses that give great vision at distance, but not as good close up, and those include extended depth of focus (EDOF) and low-add multifocals,” Dr. Donnenfeld said, adding that patients might have the expectation that they wouldn’t need glasses for reading with these lenses and, as such, ophthalmologists have been “compromising our offerings to these patients” by offering high-add multifocals at the cost of distance vision with more glare and halo, mixing and matching lenses, and employing other techniques to enhance vision with available technologies. “Trifocals give you the same reading that the high-add multifocals have, but it also gives you intermediate vision, and in my experience and international experience, they give better distance vision,” Dr. Donnenfeld, who has just been adding trifocals to his practice, said. “It really fills areas that are needed for presbyopia correction and that is intermediate vision and good quality of vision at distance.” Dr. Solomon said he thinks trifocals bring a fuller range of vision to the market. He also said it simplifies things. Before, he said, there would need to be conversations with the patients to determine what they wanted out of their lens—intermediate (computer/cellphone) vision or near (reading) vision—with compromises on one or the other. “What the trifocal brings is the opportunity to really simplify the discussion. Do you want to be able to see distance and near? The trifocal, according to the U.S. data and speaking PanOptix IOL implanted following cataract surgery. Source: Eric Donnenfeld, MD