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‘New era’ of presbyopic IOLs brings reduced glare, better vision
Recent additions to ophthalmologists' armamentaria include lower-add multifocal, extended depth-of-focus and accommodating IOLs.
New IOL technologies are providing clinicians with ways to reduce glare and halo while delivering favorable visual outcomes, according to a speaker at Hawaiian Eye 2017.
Eric D. Donnenfeld, MD, discussed the advantages of IOLs that have broadened clinicians’ options in treating presbyopia while reducing dependence on glasses.
“Overall, spectacle wear is no longer a high-wire act, and the new low-add multifocals, extended depth-of-focus and accommodating IOLs are more forgiving with dramatically less glare and halo, and they have high patient satisfaction,” Donnenfeld told colleagues.
In the past, ophthalmologists implanted high-add lenses, decreasing dependence on glasses but at the cost of distance visual acuity. High-add lenses also create larger halos and more glare, he said.
Lower-add IOLs have produced better distance vision outcomes, Donnenfeld explained. He pointed to one study that compared the Tecnis multifocal +2.75 D, +3.25 D and +4.0 D IOLs (Abbott Medical Optics) in terms of patients’ ability to function comfortably with glasses at 6 months postop.
The highest-add lens performed best at near, but outcomes reversed at greater distances.
At intermediate, 98% of patients with the +2.75 lens reported the desired outcome as compared with 97% with the +3.25 and 85% with the +4.0. At distance, the +2.75 remained at 98%, the +3.25 reached 96% and the +4.0 rose to 90%.
In another study, 3.3% of patients who received the AcrySof IQ ReSTOR +2.5 D toric IOL (Alcon) reported severe glare or flare 6 months after a second implantation, and 10.5% reported severe halos.
Patients are also more tolerant of lower-add IOLs, Donnenfeld said. In one of several studies on the matter, about 95% of patients indicated they would have a second ReSTOR +3.0 lens implanted, while roughly 90% said the same of the ReSTOR +4.0.
Donnenfeld also highlighted the advantages of the Trulign toric IOL (Bausch + Lomb).
“I call this a toric plus,” he said. “And this lens probably has the best stability of any toric lens that I’ve used and really stays where you put it due to the haptic design.”
The Trulign lens features rectangular-hinged haptics and can come in one of three cylinder powers: 1.25 D, 2 D and 2.75 D.
Roughly a year ago, lower-diopter Trulign lenses, ranging from +10 D to +16.5 D, were made available.
The Symfony extended depth of focus IOL (Abbott) offers another unique opportunity. The Symfony lens is diffractive at distance, Donnenfeld said, and reduces chromatic aberration.
Symfony IOLs can also deliver 20/20 vision despite astigmatism of up to 1.5 D, Donnenfeld said. – by Joe Green
- Reference:
- Donnenfeld ED. Update on presbyopic IOLs. Presented at: Hawaiian Eye; Jan. 16-20, 2017; Koloa, Hawaii.
- For more information:
- Eric D. Donnenfeld, MD, can be reached at Ophthalmic Consultants of Long Island, 711 Stewart Ave., Suite 160, Garden City, NY 11530; email: ericdonnenfeld@gmail.com.
Disclosure: Donnenfeld reports he is a consultant for Abbott, Alcon, Bausch + Lomb and Zeiss.