Novel asymmetric bifocal lens design provides good vision at all distances

The lens provides better contrast sensitivity, less halo and glare, and better picture quality, according to a clinician.

PARIS — A multifocal IOL with an innovative design has shown promising results, with most patients reporting good outcomes, according to a clinician.

Lentis Mplus IOL (Oculentis) has overcome the drawbacks of standard multifocal lenses from light being scattered on the foci over the entire surface, according to Magda Rau, MD. This distribution of light leads to loss of contrast and image overlapping, with consequent glare and halos.

“All other multifocal IOLs currently available on the market are based on the rotational symmetry concept, with concentric circles alternatively allowing for distance and near vision,” she said at the European Society of Cataract and Refractive Surgeons meeting. “The Lentis Mplus takes a completely new approach to multifocality. An aspheric, asymmetric far-vision zone is combined with a sector-shaped near-vision zone of +3 D, allowing for seamless transition between the far and near vision zones. In particular, glare and ‘image jumps’ caused by reflections as often experienced in twilight or in central headlight glare conditions will thus be avoided. It’s a modern intraocular version of Benjamin Franklin’s double spectacles.”

The spherical centers of the two surfaces lie on the optical axis of the sector lens. Consequently, both principal foci of the lens are on its optical axis, making image displacement impossible.

Another distinctive feature of the lens, according to Dr. Rau, is that when light hits the transition area to the embedded sector element, it is reflected away from the optical axis. This prevents any superposition of interference or diffraction normally caused by curvature variations on optical surfaces. While this causes a minor loss of light intensity, it also results in significantly improved contrast sensitivity.

“The lens keeps an almost constant light distribution, 50% for far and 45% for near by a pupil size of over 4 mm. This particular light distribution leads to minimal loss of light,” Dr. Rau said.

Implantation

“The Lentis Mplus is very flexible. The lens is injected inside the capsular bag using the Oculentis Viscoject injector with Viscoglide cartridge,” Dr. Rau said. Only a small enlargement is necessary for microcoaxial phacoemulsification cases.

Two instruments are used for positioning: a Sinskey hook and a cataract spatula to gently rotate the lens without causing stress to the zonule.

“I rotate the lens with the Sinskey hook, using the spatula as a support to prevent the lens from slipping out of the capsular bag,” she said.

The near vision sector is positioned inferiorly in the eye. The lens must be implanted with the horizontal marks in the 0° and 180° positions, which should be marked preoperatively.

Dr. Rau implanted the Lentis Mplus bilaterally in 20 eyes of 10 patients. Mean age was 68 years. Patients with bilateral cataract and a strong motivation to achieve spectacle independence were included.

“We excluded patients with too high expectations for postoperative vision, overly anxious and demanding patients, and patients who had tried multifocal glasses and were not satisfied with them,” she said.

Results

Three months after implantation, mean distance visual acuity was 20/32 uncorrected and 20/25 with correction. Uncorrected near visual acuity was 20/25.

Approximately 90% of patients were “very happy” with the results, and 10% (all men) were not satisfied with distance vision.

One patient experienced glare but did not find it disturbing, and none of the patients complained about halos.

“A high degree of spectacle independence was achieved, with 60% of the patients not wearing spectacles at all and 40% wearing them occasionally, mainly to read small print. Intermediate vision was excellent. None of the patients needed spectacles to work with the [personal computer],” Dr. Rau said

The fact that glare and halos, common reasons for dissatisfaction after multifocal IOL implantation, are reduced or even eliminated may lead to wider applicability and greater satisfaction with the Mplus compared to symmetric multifocal IOLs, she said. – by Michela Cimberle

• Magda Rau, MD, can be reached at Augenklinik Cham, Janahof 2, Cham 93413, Germany; +49-99-7186-1078; e-mail: rau@augenklinik-cham.de or info@augenklinik-cham.de.
• Disclosure: Dr. Rau has no direct financial interest in the products discussed in this article, nor is she a paid consultant for any companies mentioned.

Improvements in multifocal technology may improve multifocal outcomes. With multifocals, we are not yet at the end of the road, and innovation is still possible. If, as we have demonstrated, the Mplus Oculentis+3 significantly reduces the photic phenomena and does not create a contrast sensitivity loss, accommodating lenses will have a fierce competitor. The primary advantage of this lens is that multifocality does not need an accommodative reserve, as it does not involve a physiological mechanism affected by fatigue. A longer follow-up is mandatory to draw final conclusions.

— Jorge L. Alió, MD, PhD
OSN Europe Edition Editorial Board Member
Disclosure: Dr. Alió is a consultant for Oculentis and has received grant support.