
Opinion|Videos|May 27, 2025
Full Range of Vision IOLs for Patients Wanting Spectacle Independence
Author(s)Steven J. Dell, MD
A panelist discusses how he managed a 57-year-old tennis player with dry eye and Hashimoto thyroiditis by selecting a Toric enVista IOL for her refractive lens exchange, noting the patient’s satisfaction despite a temporary market recall of the lens.
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Video content above is prompted by the following:Refractive Lens Exchange in Patient With Dry Eye
Key Discussion Topics
- Complex patient profile
- A 57-year-old woman with Hashimoto thyroiditis and dry eye
- Low hyperope with trace nuclear sclerosis (refractive lens exchange candidate)
- Avid tennis player requiring good stereopsis
- Contact lens intolerant with dependence on reading glasses over contacts
- Preoperative management
- Preoperative optimization of ocular surface to improve topography
- Inferior steepening on topography related to dry eye, not keratoconus
- Lens selection considerations
- Monovision contraindicated due to tennis requiring stereopsis
- Extended depth of focus lenses insufficient for patient’s reading needs
- Consultation with Canadian colleagues regarding enVista intraocular lens (IOL) performance in patients with dry eye
Notable Insights and Outcomes
- Dell observed rapid visual recovery with enVista IOLs even in suboptimal corneal conditions
- Patient received a Toric enVista IOL (placed at axis 326°, 25°)
- On postoperative day 1, coinciding with a voluntary recall of the enVista IOL, patient reported excellent uncorrected distance and near vision
- At 1-week follow-up, patient remained satisfied despite the recall
- The subsequent reintroduction of enVista to the market allowed for potential matching IOL placement in the fellow eye
Concluding Observations
- Late laser vision correction enhancements remain complicated but increasingly important
- PRK is likely the best option for enhancement after laser vision correction, though still imperfect
- Modern IOL designs have made refractive precision critical in this demanding patient population
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