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Trying new IOL technologies
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Newer IOL designs are getting better and better, giving a wider range of vision, from near to far, with higher image quality. But the only perfect lens is the natural one in 22-year-olds, so it's important to let our patients know that while our goal may be perfect vision, there's no way we can guarantee that. I currently use the full spectrum of presbyopic IOLs, from accommodating to multifocal, with the aim of tailoring the vision to each patient's specific visual needs, ocular conditions and biometry. I've recently started to incorporate the new AMO Tecnis multifocal aspheric IOL and the Alcon ReSTOR with the lower +3 D add.
 Tecnis multifocal IOL well-centered in the visual axis. |
These are both diffractive designs on acrylic platforms, but with some important differences: The Tecnis multifocal has diffractive rings out to the periphery so that it can provide consistent near vision despite larger pupil sizes, such as found with dimmer lighting conditions. The ReSTOR +3 D provides better intermediate vision than its predecessor, the ReSTOR +4 D, with a revised design that places the diffractive rings in a new pattern in the center of the lens. Both designs require precise biometry and surgical technique, with patients getting the best vision if they are within 0.5 D of plano with 0.5 D or less of astigmatism.
The best way for a surgeon to become familiar with these new designs is to try them. Choose patients who are somewhat hyperopic, with significant cataracts but no significant corneal astigmatism. These patients are most likely to be impressed by the resultant vision, and they will be appreciative of their new near vision. As much as you love your current favorite IOL, remember that no lens design is perfect and that you may be impressed by some of the newer IOL technologies. The only way to know is to try.