BLOG: A presbyopia-correcting lens for nearly every eye
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For almost 20 years now, we have been using presbyopia-correcting lens implants. But an important caveat that came with all of them is that they can only be used safely in eyes with near-perfect visual potential.
Multifocal lenses, which contribute some loss of contrast, could potentially complicate vision for patients with other disease. Personally, I limited my use of these lenses to patients with 20/25 or better visual potential and no signs of Fuchs’ dystrophy, significant macular degeneration, irregular astigmatism or other comorbidities. (The accommodating Crystalens from Bausch + Lomb offered a guarded exception to this rule but is not used much today.)
New implants have effectively challenged this requirement for a “perfect” eye. The nondiffractive multifocal Vivity implant from Alcon and, to a lesser extent, the Eyhance (although not labeled as a presbyopia-correcting lens) from Johnson & Johnson Vision induce no more visual disturbances than monofocal lenses, and both offer a pleasing extended range of vision to patients.
The manufacturers’ promises do appear to be true, and we have significantly broadened the pool of candidates for presbyopia correction. For me, they have replaced much of my use of torics and other multifocal lenses. Along with Mike Jones and Quentin Allen, I am publishing a series of 60 bilateral patients with Vivity, and the presence and severity of glare and halos are significantly lower than with any multifocal we have ever studied. About half of patients need reading glasses only rarely or never. Virtually all can function uncorrected for driving and computer work. Patients with comorbidities get similar results, assuming their visual potential can support these activities. As always, careful discussion about expectations must be customized to every patient.
I would offer most patients with near-perfect eyes the trifocal PanOptix from Alcon or Synergy from Johnson & Johnson Vision. Our own recent evaluation of 59 patients with bilateral PanOptix showed 83% were completely free of glasses for all activities under all circumstances. That’s a remarkable statistic and one I share with patients, who are appropriately impressed. Of course, patients must be willing to accept some glare and halos with these trifocals, and our survey studies showed about the same frequency and severity as with previous multifocals.
So, for healthy eyes in patients willing to tolerate a bit of halos, PanOptix and Synergy earn us lots of well-deserved five-star reviews. For those wary of halos or those with a less-perfect visual system, we still have an effective implant to address presbyopia in Vivity. Everyone wins.
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