Something old, new, borrowed, blue: Premium IOL trends
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Not to cause any confusion for those reading my Premium Channel column, but this premium eye surgeon is not getting married again any time soon.
But I thought this traditional wedding rhyme was appropriate for what is happening in the world of premium IOLs today. The rhyme originated in the late 1800s, with the old item providing protection for the baby to come, the new item offering optimism for the future, the borrowed item from another happily married couple signifying good luck, and the blue item meaning a sign of purity and fidelity. Not sure how any of this relates to premium IOL technology, but here is my stab at such.
Something old
It is amazing that the Light Adjustable Lens (LAL, RxSight) is no longer the new kid on the block as it was approved by the FDA in late 2017, nearly 6 years ago. The good news is that it is still my go-to premium IOL for a variety of reasons: adjustability, invisibility, customizability and profitability.
In terms of adjustability, I can deliver the best clinical outcomes by performing refractive adjustments without corneal/ocular healing effects and get instantaneous results by the next day once the pupillary dilation wears off. With this technology you can perform up to three adjustments and a mandatory two lock-in treatments. My average adjustment is now 1.3 after 6 years of implanting this technology. In terms of invisibility, the LAL utilizes built-in ActivShield UV protection to reduce the concern of patient compliance postoperatively. I now only recommend that patients wear the mandatory UV protective glasses until final lock-in while they are outside day or night. In terms of customizability, the premium customized blended vision due to the LAL’s inherent extended depth of focus capability has ended up putting most of my patients at uncorrected near vision levels of J1 to J2 on average, better than the J3 seen with most presbyopia-correcting IOLs of the past. Lastly, in terms of profitability, there are higher practice revenues and profits with this technology because the additional work postoperatively justifies the higher fees. I like to refer to the additional work as “good chair time” because patients are excited to see continued improvement in their visual outcomes.
Something new
The PanOptix trifocal IOL (Alcon) is not that new, but the Clareon material has been a great addition to this technology, essentially eliminating the presence of glistenings, which cause retinal light scatter and secondary visual side effects. The beauty of this trifocal technology is its reproducibility in visual outcomes, and it has been an excellent option for those patients who cannot tolerate any type of blended vision approach. This has been my go-to premium IOL, with great success, in patients who tend to use near vision beyond cell phone usage. My only advice with this technology is that if you need to enhance a patient, make sure your corneal topography, tomography and epithelial mapping allow for a PRK/SMILE/LASIK enhancement capability postoperatively.
Something borrowed
This is the hardest category in which to place a premium IOL, but I feel the new segmented bifocal IOL from Lenstec, the SBL-3, borrows our traditional bifocal glasses concept to give a high level of near, intermediate and distance vision with a limited number of visual side effects. This IOL comes in 0.25 D increments to nail the end target, and the SBL-3 comes with a 3 D sector-shaped add with a seamless transition zone between distance and near segments. Orientation of this premium IOL is important as well.
Something blue
The Tecnis Symfony OptiBlue (Johnson & Johnson Vision) combines the effects of extended depth of focus technology and power by InteliLight to mitigate dysphotopsia, including halos, glare and starbursts. This “blue” technology results in less nighttime frustration while maintaining a great broad range of vision. This IOL has a higher resolution lathing process in its echelette design compared with its predecessor, corrects for chromatic aberration to enhance image contrast day and night, and mitigates halos, glare and starbursts with its violet light filter.
In summary, you never know when an old rhyme can come in handy, married or not, when discussing premium IOL options. The future looks bright for our premium IOL technologies with future accommodating IOLs on the horizon. Stay safe and stay premium.
- For more information:
- Mitchell A. Jackson, MD, of Jacksoneye in Lake Villa, Illinois, can be reached at mjlaserdoc@msn.com.
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