IOL-related advances increase satisfaction, improve toric outcomes
IOLs are proving to provide new options for cataract surgeons as well as entryways for more advanced research trials.
Reviewed by Malik Y. Kahook, MD, Samuel Masket, MD, and Mark Packer, MD
At the end of 2014, news about pseudophakic IOLs made headlines when the FDA’s Ophthalmic Devices Advisory Committee panel overwhelmingly recommended PMA approval of the AcrySof IQ ReSTOR Multifocal Toric IOL (Alcon Laboratories).
Approaching 2016, cataract surgeons in the United States are still waiting to access the technology and other premium channel implants available around the world.
Nevertheless, multiple noteworthy developments for pseudophakic IOLs occurred in 2015; Malik Y. Kahook, MD, Nick A. Mamalis, MD, Samuel Masket, MD, and Mark Packer, MD, spoke to Ophthalmology Times about recent and forthcoming advances.
New options for existing platforms
The introduction of lower add power multifocal IOLs-the AcrySof IQ ReSTOR +2.5 D Multifocal IOL (Alcon) and the Tecnis Multifocal +2.75 D and +3.25 D Multifocal IOLs (Abbott Medical Optics)-has been a great benefit considering the limitations of the previous versions of those platforms, noted Dr. Packer, clinical associate professor of ophthalmology, Oregon Health and Science University, Portland.
“The ReSTOR and Tecnis are really bifocal lenses with two distinct focal points, and so there is a gap area of lower acuity at intermediate distances,” he said.
Patients were not entirely satisfied with the original ReSTORE +4.0D because the near point was too close due to the add power and the diffractive surface on the front of the lens. And while near focus was not a problem with the Tecnis+4.0D due to the diffractive element being on the posterior lens surface, they would notice a blur between the near and distance vision, which happens to be where computer screens are normally positioned, he explained.
“Now with the lower add power versions and especially with the ability to provide blended vision using different power IOLs in the dominant and non-dominant eyes, it is possible to fill that intermediate space,” Dr. Packer said.
“These new lenses bring opportunity for achieving happier patients and really allow cataract surgeons to provide freedom from glasses for a vast majority of the people who elect multifocal IOL surgery,” he said.
Dr. Packer noted that the new lower add power multifocal IOLs are not perfect as they have not completely eliminated other issues associated with multifocal IOLs, such as halos and glare. However, the latter issues have been addressed by some novel design modifications to the ReSTOR +2.5 D, which include increased light distribution through the center zone combined with a reduced number of rings in the apodized diffractive multifocal zone (7 with the ReSTOR +2.5 vs. 9 with the ReSTOR +3.0).
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