New-generation IOL is glistening-free

Take home

The absence of glistening formation is among the advantages associated with new IOL technology, relates one ophthalmologist.

Dr. Goldberg

By Lynda Charters; Reviewed by Lawrence R. Goldberg, MD

St. Petersburg, FL-A new glistening-free, hydrophobic acrylic (enVista, Bausch + Lomb) seems to be a step forward in IOL technology in that it has major advantages and very few disadvantages, according to one ophthalmologist.

Though the IOL is relatively new to the market, Lawrence R. Goldberg, MD, is enthusiastic about its performance.

The hydrophobic acrylic IOL is designed to provide visual correction of aphakia in adults who have undergone removal of a cataractous crystalline lens with powers that range from 0 to +34 D. The lens is J-shaped, foldable, and very clear with no tint, which Dr. Goldberg prefers. Because this lens is not a premium IOL, it is covered by insurance.

Absence of glistening formation

By far the greatest benefit of this IOL is that it is glistening-free, according to Dr. Goldberg. He previously used the SN60WF IOL (Alcon Laboratories) almost exclusively in his practice, however, the major drawback of that IOL was the formation of glistenings.

From 10% to 15% of patients had a significant formation of glistenings throughout the lens, he noted.

“The glistenings were so extensive that it might affect contrast sensitivity even though the visual acuity was 20/20 to 20/25,” he said.

With the introduction of the new hydrophobic acrylic IOL slightly over a year ago, Dr. Goldberg was impressed by the reported absence of glistening formation and began to use the lens in his practice in St. Petersburg, FL.

“I liked what I saw with my patients, and no glistenings have formed in the lenses,” Dr. Goldberg said. “However, right now, it is too early to state that glistenings will never form because they usually form about 1 or 2 years after implantation in the SN50WF IOL.”

Thus far, his patients have had no problems with the IOL postoperatively. The lenses have remained crystal clear. The IOL is stable in the bag, and all patients in a study sponsored by the manufacturer had 5° or less of IOL rotation between days 30 and 180 after implantation.

Resistant to scratches and abrasions

Another advantage is that the lens is scratch- and abrasion-resistant, Dr. Goldberg noted.

“It is a tough lens that does not scratch or tear,” he said. “The SN60WF IOL can tear occasionally, because it gets caught in the injector and I would have to pull it out.

Dr. Goldberg also has noted the occurrence of small cracks in the optic after uneventful injection of the SN60WF IOL into the capsular bag in a few patients.

“The enVista lens pops out of the injector smoothly,” he said. “It has a harder surface and does not scratch or crack.”

The IOL also has an aberration-free aspheric optic that enhances contrast sensitivity. Posterior capsular opacification should be minimal because of the IOL’s 360° square posterior edge and step-vaulted haptics for direct contact with the capsular bag.

The IOL can be inserted through a 2.2-mm wound assist or a 2.4-mm in-the-bag incision during a standard phacoemulsification procedure.

The only drawback to the hydrophobic acrylic IOL, Dr. Goldberg pointed out, is that compared with other IOLs, it unfolds slowly because it is a bit stiffer. However, this is not a deal-breaker for him.

“Because it is stiffer, the IOL will hold up better in the event of a trauma if the injection process is not perfect,” he said.

Dr. Goldberg also has first-hand experience with the lens (see “Surgeon has lens implanted in his eyes”), and he sees this as an advantage when explaining the cataract procedure to his patients.

“The surgery was a piece of cake and pain-free,” he said. “I tell my patients that the procedure is easier than they think. The worst part is the preoperative anticipation.”

Lawrence R. Goldberg, MD

E: rhinoeye@yahoo.com

Dr. Goldberg has no proprietary interest in the technology.

Surgeon has lens implanted in his eyes

Results achieved with the hydrophobic acyclic IOL (enVista, Bausch + Lomb) have impressed Lawrence R. Goldberg, MD, so much so that it was the lens of choice for his own bilateral cataract surgeries-especially because of the absence of glistening formation and positive feedback from colleagues.

Surgery on the right eye was performed July 19 and that on the left eye Aug. 13, 2013, to address a nuclear cataract and a posterior subcapsular cataract.

The cataract in the right eye was substantially worse, and the vision had decreased to about 20/40 without glare testing. The vision in the other eye was still 20/20.

After undergoing surgery in the right eyes, Dr. Goldberg’s eyeglass correction had gone from 5 D of hyperopia preoperatively (a similar correction was present in his left eye) to a spherical equivalent of plano 1 week postoperatively.

Due to significant anisometropia, Dr. Goldberg was unable to wear a temporary lens in his right eye along with his highly hyperopic lens in his left eye. He decided to have surgery 1 month later in his left eye despite the 20/20 corrected vision in that eye.

In the short time between the surgeries, Dr. Goldberg noticed how much brighter the vision was in the right eye with the IOL implanted compared with the fellow eye. He also noticed the difference in coloration between the two eyes at that time, with a tan shading of objects seen with the left eye.

Dr. Goldberg commented that he almost could not tell that he had undergone the cataract surgeries, with the exception that he no longer needs to wear glasses to correct the preoperative hyperopia.

“My distance vision is great, even without glasses,” Dr. Goldberg said. “I have a small amount of distance correction and I will add to the progressive lens power so that I don’t have to take the glasses on and off for reading.

“However, I can still read a little without the glasses,” he said. “It is phenomenal.”

A small difference that Dr. Goldberg noticed since the cataract surgery is that when he is outside in bright sunlight, vision seems slightly brighter.

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