EyeWorld India December 2021 Issue

REFRACTIVE 24 EWAP DECEMBER 2021 Contact information Donnenfeld: ericdonnenfeld@gmail.com Williamson: blakewilliamson@weceye.com Yeu: eyeulin@gmail.com T here has been a lot of movement in the presbyopia- correcting IOL space. In the July issue of EyeWorld, the YES Connect column took a look at “ringless” extended depth of focus (EDOF) technologies. This column moves the conversation forward along the presbyopia-correction spectrum, examining trifocal, combined multifocal-EDOF, and accommodating technology on the horizon. Trifocals The AcrySof IQ PanOptix (Alcon) became the first trifocal approved for use in the U.S. in August 2019. In the 2 years post-approval, surgeons who have adopted it, like Elizabeth Yeu, MD, have become familiar with its pros and cons. Dr. Yeu was part of the FDA pivotal trial for PanOptix and said that of the multifocal IOL options, it’s what she uses Improvements in presbyopia-correcting IOLs continue by Liz Hillman Editorial Co-Director most frequently in her practice when patients desire spectacle independence and are good candidates. Prior to PanOptix, Dr. Yeu said there was a significant gap at intermediate vision in multifocal IOL technology. Surgeons mixed and matched IOLs to try to accommodate for this, or patients had to move their arms in and out to try to find the sweet spot. PanOptix, Dr. Yeu said, reduced her need to mix and match IOLs. Its near sweet spot at –2.5 D or 40 cm and intermediate at –1.5 or 60 cm, coupled with distance vision, provides “the most ideal range for any one who is, from the perspective of an optic and arm’s length, less than 6’10”,” she quipped. Another benefit of PanOptix, Dr. Yeu continued, is its platform. While the lens is AcrySof material, it’s based on its own new platform, which uses 88% of light, half of which is directed toward distance. “It has incredible light utilization,” Dr. Yeu said. She said that for a light- splitting technology, the concerns over contrast sensitivity are less than observed in the clinical trial. You still have to respect the patient selection rules as you normally would for multifocality, she noted, which include a stable ocular surface and no other intraocular pathology. “If those rules are observed, it works extremely well in patients,” Dr. Yeu said. The addition of Vivity (Alcon), a non-diffractive EDOF, to the market earlier this year, Dr. Yeu said, has expanded who she is comfortable offering PanOptix to. Here’s how: She has been mixing and matching Vivity and PanOptix for patients who are very concerned with the night dysphotopsia profile of the trifocal. Patients who are younger and 20/20 with mild cataracts complaining of glare would give her pause with PanOptix alone, Dr. Yeu said, but coupling it with Vivity in the dominant eye mitigates the dysphotopsia profile of PanOptix in the non-dominant eye. “Patients have loved that,” she said. “It’s not my go-to, but it has expanded who I am able to offer it to.” Overall, Dr. Yeu said there is a high level of satisfaction among patients and surgeons with PanOptix. “This lens technology has created that easy button. It allows for it to be an easier conversation that we can have our counselors partake in. It helps to enable proper education and expectations for the patient, and it meets those expectations, even exceeds them,” she said. Combination multifocal- EDOF TECNIS Synergy (Johnson & Johnson Vision), which combines multifocal diffractive and extended depth of focus technology, received FDA approval in May. Blake Williamson, MD, and Eric This article originally appeared in the September 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Dr. Williamson implants the first Synergy in Louisiana. Source: Blake Williamson, MD