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New-generation trifocal and EDOF lenses simplify choices, expand indications
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ROME — After positive and negative experiences with refractive and diffractive multifocal IOLs over several years, selection has become simpler with the new generation of trifocal and extended depth of focus lenses. They are used more frequently and indications are expanding, according to Hiroko Bissen-Miyajima, MD, PhD, 2019 Antonio Scarpa SOI Medal Lecturer at the OSN Italy meeting.
“It used to be complicated, but now we can focus on those two types and make our choice based on the patients’ requirements for near vision,” she said.
Statistically, people older than 60 years of age prefer a lens with a high performance at a shorter distance of 30 cm, while younger generations, for which smartphones, tablets and computers have largely replaced books and newspapers, require a slightly longer distance of 40 cm or 50 cm.
“Looking at lifestyles, for the patients who engage a lot in near activities such as reading and sewing, I choose a lens with higher near addition. For those who make frequent use of computers, do sports, drive at night and feel OK using reading glasses if it is necessary, I choose an IOL with lower near addition,” she said.
Among high near addition lenses, Bissen-Miyajima preferentially uses the PhysIOL trifocal FineVision and the Alcon PanOptix. In a retrospective study at her hospital in Tokyo, the FineVision lens provided good vision at 40 cm to 70 cm as well as at 5 m, contrast sensitivity was within normal range, and there was almost zero use of spectacles. The PanOptix lens also performed well in a prospective study carried out in Japan, with binocular uncorrected vision over 20/20 at all distances.
When a low near add is required, the Symfony EDOF (Johnson & Johnson Vision) is the option Bissen-Miyajima most often uses now. Retrospective data show good outcomes in the distance and intermediate range, decreasing at about 40 cm.
“I can target postoperative refraction at –0.5 D, but patients still require reading glasses for small print. Japanese and Chinese characters are more complicated compared to alphabet, which explains why more than 50% of patients in our study are using spectacles for near. On the other hand, contrast sensitivity is amazing, even at high frequencies,” Bissen-Miyajima said.
Due to the high contrast sensitivity performance, EDOF indications may expand to difficult cases such as glaucoma, epiretinal membrane and post-LASIK patients, in which contrast sensitivity is a concern.
“We implanted patients with well-controlled glaucoma and found that vision at all distances was comparable to normal eyes, and so was [contrast sensitivity]. One patient with [epiretinal membrane] in one eye implanted with the EDOF IOL in both eyes did not perceive the difference between the two eyes. Post-LASIK patients, who have decreased [contrast sensitivity] after multifocal lens implantation, do much better with EDOF,” Bissen-Miyajima said. – by Michela Cimberle
Reference:
Bissen-Miyajima H. Presbyopia-correcting intraocular lenses: Where are we now? OSN Italy meeting; May 24-25, 2019; Rome.
Disclosure: Bissen-Miyajima reports she is a consultant with Alcon, Johnson & Johnson, Hoya, Zeiss and Santen.