Multifocal Intraocular Lenses

VIENNA — In this Healio Video Perspective from the ESCRS meeting, José Vargas, MD, speaks about his experience as a surgeon and as a patient who recently underwent cataract surgery.

NEW ORLEANS — The $210 billion spent annually on global vision correction suggests potential growth for refractive surgery, according to a speaker.

It’s amazing to think of all the science and technology utilized for cataract surgery, from sophisticated biometry and preoperative surgical guidance and planning tools to the latest femtosecond lasers, phaco machines and multifocal IOLs.

AMELIA ISLAND, Fla. — George O. Waring IV, MD, presented here clinical pearls for the Tecnis Synergy at the first live meeting presentation since the approval of the Johnson & Johnson Vision IOL in early May 2021.

The ideal lens for our eyes is the one that we had in our youth. The young human crystalline lens provides outstanding image quality and a large degree of accommodation, giving the widest range of vision.

Glaucoma patients deserve the best level of care, and this includes any new technologies that allow them to improve vision. However, it is important to consider what their current vision capabilities are, what they are going to be in the future and how that relates to the technologies that are currently available. The prime example would be patients who have glaucoma or are at risk for glaucoma and want multifocal IOLs after cataract surgery. If they have moderate or advanced glaucoma, they already have visual field defect, and this would adversely affect the refractive outcomes. It is like having a high-definition TV but not having the cable line to receive the signal. On the other hand, I have a fair number of ocular hypertension or mild glaucoma patients who have good control over their glaucoma and likely will never develop visual field defect. They understand their disease and are doing a good job at taking care of it. For those patients, this IOL technology may be appropriate.

When neuroadaptation fails, exchanging a multifocal IOL without giving up multifocality is feasible and fulfills patients’ expectations for premium vision, according to a study.

After years of successfully recommending and implanting multifocal IOLs, I was excited to transition to extended depth of focus lenses when the Tecnis Symfony IOL from Johnson & Johnson Vision was introduced. I truly believe that EDOF lenses are an improvement over multifocal technology because of the forgiving nature of the optics and the high-quality vision they offer over a wide range, with no gaps or “sweet spots.”

Presbyopia is very common, estimated to affect 120 million Americans and just more than 2 billion people globally. After decades of being limited to spectacles and contact lenses to overcome the handicap of presbyopia, we and our patients now also have pharmacologic and surgical treatment options available or in development. In this commentary, I will share some personal thoughts on how we might evaluate these treatments in regard to efficacy, safety and patient acceptance. The opinions expressed are my own but are based on being an engaged participant in research and development in the field of optical, medical and surgical treatment of presbyopia for 35 years. I will disclose that I work widely in this field and consult for companies large and small, and that I own equity and have served as a paid consultant, a medical advisory board member and even on the board of directors of companies with the goal of treating presbyopia. I may ramble a bit, but in the end, I believe my comments will at a minimum catalyze your thinking.

Angle kappa has long been a point of consideration for adequate centration of multifocal IOLs. Good centration is important to maximize the visual quality and minimize the visual side effects. Proper centration of multifocal IOLs has always been a point of contention as the successful outcome of the surgery depends on it. There are some patients who undergo a successful multifocal IOL implantation and are unhappy despite good Snellen visual acuity. This has been attributed to a comparative decrease in contrast sensitivity along with the appearance of halos and glare. Clinically, the centration of a multifocal IOL is checked with its concentricity of the rings to the pupil but rarely an effort is made to check its alignment with the visual axis.