All IOLs come with pros and cons
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CHICAGO — Ophthalmologists now have many IOL options for patients who want to be spectacle free, but none are the perfect solution, according to one speaker here.
Optical strategies to increase depth of focus include diffractive, pinhole and aspheric defocus optics. There are also accommodating lenses, but none have yet achieved truly satisfactory outcomes, Julie Schallhorn, MD, MS, said at Refractive Surgery Subspecialty Day at the American Academy of Ophthalmology meeting.
Diffractive optics work well for near and distance vision but come with side effects due to their inherent characteristics. They also generate aberrations.
“They are optimal only in a healthy eye because the efficiency of light transmission is dependent on the incident angle. In irregular corneas with irregular tear film, the light transmission efficiency goes down, affecting contrast sensitivity,” Schallhorn said.
Pinhole optics are less sensitive to corneal irregularities, but they also have drawbacks.
“A small aperture increases depth of focus but decreases monocular contrast sensitivity,” Schallhorn said.
Aspheric defocus optics are also less sensitive to tear film abnormalities, but decreased contrast sensitivity is a feature of all IOLs with spherical aberration.
“Optics are cool, but all our current IOLs make tradeoffs between light transmission and increased range of focus,” Schallhorn said. “Knowing the behavior of the optical solutions you have is critical to offer your patients the best options for best outcomes.”
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