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Publication Exclusive: Pursuit of ideal presbyopia-correcting IOL continues
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The options available for the surgical correction of presbyopia with an IOL implant continue to expand. The potential indications for the treatment of presbyopia also continue to expand. Every patient who undergoes cataract surgery is potentially a candidate for a presbyopia-correcting IOL if we had a technology that did not degrade quality of vision and retained stereopsis and binocular summation. In addition, because the etiology of presbyopia resides in the lens, it is patently obvious to both patients and surgeons that a lens-based solution is logical.
The defining of the so-called dysfunctional lens syndrome, which includes presbyopia along with a reduced quality of vision from increased higher-order aberrations, light scatter and reduced contrast sensitivity in the aging natural lens, has helped both surgeons and patients better understand the problem. Elective patient pay refractive lens exchange for the treatment of dysfunctional lens syndrome is becoming more common in many practices with high patient satisfaction.
We now have four categories of lens implants to use when treating presbyopia: the monofocal IOL, the multifocal IOL, the extended depth of focus IOL and the accommodating IOL. A few personal thoughts on each of these categories. As a disclosure, I consult with companies on products in all these categories.
Monovision or blended vision remains the most common approach to treating presbyopia in the U.S., accounting for as many as 25% of total patients implanted, or nearly 900,000 patients a year. I find this to be an excellent option, even in patients with mild ocular pathology. I always target between –1.25 D and –1.75 D of myopia in the near eye, and several well-done studies support this refractive target. Most patients tolerate either the dominant or nondominant eye as the near eye, and ocular dominance is difficult to determine in the patient with significant cataracts that are asymmetric. I like to do the worst cataract first and prefer to target this eye for distance. I then target the second eye for near. Excellent vision is required in the distance eye, and I find my enhancement rate to be 10% to 15%.
Click here to read the full publication exclusive, Lindstrom's Perspective, published in Ocular Surgery News U.S. Edition, October 10, 2015.