New IOL technology both fuels, meets rising expectations of cataract patients

The newest frontier in cataract surgery is how to address the new paradigm in patient expectations, said Y. Ralph Chu, MD, medical director, Chu Laser Eye Institute PA, Edina, MN.

"The evolution in IOL technology has brought forth an exciting time in cataract surgery, but also a change in patient mindset," Dr. Chu said. "As the size of the older population is growing dramatically, there is a great opportunity for cataract surgeons. However, we need to evolve by improving our skills and expanding our repertoire to keep up with patient expectations."

Currently, 90 million people in the United States are ages 42 to 60 years, he said, adding that by 2011, one-fourth of the U.S. population will be age 40 or over. As these adults reach cataract surgery age, it is important to recognize that their vision needs differ from those of previous generations, he said.

"This baby-boomer population is more technology savvy and has greater demands for good near and intermediate vision," Dr. Chu said. "In addition, they are looking for IOL technology that can improve not just vision quantity, but also the quality of their vision in a variety of lighting situations."

The expanding IOL portfolio is allowing cataract surgeons to meet those needs. As a first measure, surgeons can offer patients an aspheric IOL rather than a standard monofocal spherical lens. Presbyopia-correcting IOLs represent the next step. Newer generation refractive and diffractive IOLs provide a good range of vision accompanied by fewer problems with glare and halos. Mixing and matching multifocal IOL models can be an option for some patients to optimize comfort, contrast sensitivity, and spectacle independence.

More options are on the horizon. A three-piece silicone multifocal lens available in Europe (Tecnis ZM900, Advanced Medical Optics) features a diffractive surface across the entire optic. The lens has been associated with favorable visual acuity outcomes and excellent vision quality because of its aspheric design, according to Dr. Chu.

In addition, Dr. Chu noted he is an investigator in the FDA clinical trial of the dual-optic accommodating IOL (Synchrony, Visiogen) and that anecdotally, some of his patients are achieving up to 6 D of accommodation.