EyeWorld India June 2021 Issue

CATARACT EWAP JUNE 2021 19 range of vision IOL that provides high-contrast vision even in low light. It has violet light-blocking technology to reduce halos. LuxSmart is a preloaded IOL that gives extended depth of focus with violet filters. Another option, Tecnis Eyhance (Johnson & Johnson Vision), which recently became available in the U.S., fits in the monofocal category. Sumit “Sam” Garg, MD, thinks the approach with Eyhance is interesting, though he thinks both Eyhance and Vivity will have dysphotopsias to some extent and, as before, the expectation for these should be set with the patient preoperatively. (For more on Eyhance, see sidebar.) Synergy, Dr. Garg said, mixes multifocal and extended depth of focus technologies, and he thinks it will do well overall. “It gives similar range, maybe better range, than a trifocal,” he said. Eric Donnenfeld, MD, said that even though they’re a year or two old now, PanOptix (Alcon) and Tecnis Symfony (Johnson & Johnson Vision) should be mentioned as well. “Symfony has a great range of vision with minimal distance problems,” he said. Dr. Donnenfeld discussed a combination of Vivity in one eye and PanOptix in the other giving better spectacle-free near vision than Vivity alone and better clarity and distance vision than PanOptix alone. “If I want to have the best chance of having complete spectacle independence, PanOptix would still be the lens to choose,” he said, noting that Vivity is better for patients who don’t want to compromise distance vision in any way. Dr. Donnenfeld also mentioned iPure (BVI), which is a preloaded IOL that provides high contrast in low light and depth of field. According to BVI’s website, the lens is a monofocal that is designed to “maintain natural corneal depth of focus.” The IC-8 (AcuFocus) and XtraFocus (Morcher) are pinhole IOLs, currently approved for use outside the U.S. Dr. McCabe said she thinks this type of technology will be important to address aberrated corneas. “We don’t have anything else to help in that area, which is why I think it’s a unique solution for us in the future,” she said. Adjustable IOLs The ability to adjust refraction postop, allowing patients to experience their vision for a time and change it, if necessary, before it’s locked in is currently available in the U.S. with the Light Adjustable Lens (LAL, RxSight). Though it’s been available for more than a year, John Vukich, Chee Soon Phaik, MD Senior Consultant, Singapore National Eye Centre 11 Third Hospital Avenue, Singapore 168751 chee.soon.phaik@singhealth.com.sg ASIA-PACIFIC PERSPECTIVES I n the recent years, the industry focus has been on creating IOLs with optics that deliver better quality of vision and reduce unwanted visual phenomena while providing a functional range of vision. This article nicely classifies and discusses the various new IOLs that have been made available to ophthalmologists in the U.S. However, in Asia, many of us still have no to access to some of these IOLs. Over the last 2 years, I have enjoyed using Tecnis Eyhance (Johnson& Johnson Vision) especially when practicing monovision. I like to refer to this as a monofocal plus IOL. My patients immediately understand that the small added depth of vision gained with this IOL does not take away from their quality of vision. With the non-dominant eye targeting –1.50 D, most patients are able to see intermediate and read unaided. Thus, with the dominant eye having good distance vision, we are able to provide reduced spectacle dependence. The advantages are that this IOL functions as a monofocal IOL without downsides and is priced reasonably. This has been my go-to monofocal IOL when there is minimal astigmatism, as the toric version is currently unavailable. The concept of an enhanced depth of focus IOL is appealing but the initial IOL options have not performed to expectation. My early experience with AcrySof IQ Vivity (Alcon) has been positive, with patients having excellent quality of distance vision and good intermediate and near vision, without unwanted visual side effects. This may eventually become my default IOL, replacing a monofocal IOL. However, to achieve an extensive range of vision yet having limited visual phenomena, the diffractive trifocal PanOptix (Alcon) is still an excellent choice. Tecnis Synergy (Johnson& Johnson Vision) provides a wider range of vision with good near vision as close up as 33 cm and is thus especially useful for patients such as high myopes or patients with shorter arms who are accustomed to reading at close distance. I am looking forward to implanting Intensity (Hanita Lenses). This new polyfocal diffractive IOL maximizes light efficiency over a full range of vision with only 6.5% light loss. Early results of this IOL are highly promising. None of the accomodative IOLs are currently commercially available, but results of the Juvene (LensGen) are favorable and exciting. Adjustable IOLs can help one achieve the perfect refractive outcome consistently and may be useful in eyes with difficult biometric calculations. Editors’ note: Dr. Chee declared no relevant financial interests.