Getting the Most out of Three IOLs

“The aspheric design of this multifocal IOL enhances patients’ outcomes”, says Elizabeth A. Davis, MD. “There are a number of different IOLs to choose from to achieve the best outcome for patients today. Presbyopic correction lenses are now available and with good results. In many cases, surgeons prefer the Tecnis Multifocal IOL (Abbott Medical Optics Inc. [AMO]) based on their design and positive outcomes.”

In assessing any IOL, you must consider several factors: ease of implantation, predictability of refractive outcome, quality of vision, range of focus (spectacle independence), patients’ satisfaction, side effects, and long-term stability.

The Tecnis Multifocal IOL is based on an aspheric optic design meant to reduce the spherical aberration of an average cornea to zero. The Tecnis Multifocal has a full-diffractive posterior surface, which makes the diffractive optics pupil independent for optimal image quality at all distances under any lighting condition. The optic is made of acrylic and comes in both a one- and three-piece design. The frosted edge also minimizes edge glare.

Experience With The Lens

In a clinical trial, 94.6{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of subjects implanted bilaterally with the lens reported being satisfied with their vision. Also at 1 year, 92.1{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of the subjects had 20/25 or better distance UCVA and saw 20/32 or better at near with distance correction in place. More than 86{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of subjects reported never wearing glasses, and slightly less than 90{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} were able to function comfortably without glasses at all distances (96.9{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} at near, 89.7{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} at intermediate, and 95.5{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} at distance).Only 1{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} always wore glasses.

All multifocal IOLs inherently reduce contrast and induce some amount of glare and halos, it is important to inform all patients that they should anticipate such side effects.  Achieving optimal refractive outcomes with the Tecnis Multifocal IOL requires careful preoperative, intraoperative, and postoperative care. Preoperative preparation requires optimization of the ocular surface, a thorough examination to exclude patients with conditions that would preclude good outcomes, and precise biometry and IOL calculations.

To achieve the best results with the lens, it is important to choose appropriate candidates. Certainly, patients should desire reduced dependence on glasses and contact lenses. They should understand not only the risks of cataract surgery in general but the potential side effects of the lens, including reduced contrast, glare, and halos. Either patients should have minimal corneal astigmatism, or the surgeon should have an appropriate method to manage astigmatism. Accurate preoperative keratometric and biometric measurements are critical, and ocular surface disease must be aggressively treated.

Presbyopia-correcting IOLs are one of the most important transforming factors in the practice of anterior segment ophthalmology, and the AcrySof IQ Restor (Alcon Laboratories, Inc.) diffractive multifocal lens is the most commonly implanted presbyopia-correcting IOL in the United States. This technology offers patients visual rehabilitation for functional distance, reading, and intermediate vision. The surgeon’s selection of patients, meticulous attention to detail, and optimization of postoperative results are the keys to successful outcomes with this lens.

Recent advances in technology with laser cataract surgery may permit greater centration and consistent sizing of the capsulorhexis that could enhance refractive outcomes with presbyopia-correcting IOLs. Accurate biometry with the IOLMaster (Carl Zeiss Meditec, Inc.) or the Lenstar LS 900 (Haag-Streit AG) and control of astigmatism are also essential to maximizing outcomes. Because the lens constant must be carefully personalized to the individual surgeon, tracking postoperative results is imperative to refine surgical outcomes.

Patients are incredibly sensitive to small refractive errors with presbyopia-correcting IOLs, so surgeons must be willing and able to treat them. Astigmatism of greater than 0.50 D in a symptomatic patient requires surgical planning.

With attention to residual refractive error, the ocular surface,2 cystoid macular edema, and the posterior capsule, surgeons can improve appropriate patients’ quality of vision with the AcrySof IQ Restor IOL. The technology has enhanced the quality of life of many pseudophakic patients by reducing or eliminating their need for spectacles. As physicians’ comfort with multifocal lenses improves in the coming years, these IOLs should become more popular, both with cataract and refractive surgeons and their patients.

At Laser Locators we carry the top name surgical and diagnostic ophthalmic equipment manufacturers you can trust, like Acon, Nidek, Lumenis and more for preforming all of your precise ophthalmic procedures. Contact us at www.laserlocators.com  or call 1-877-924-2020 and let one of our expert equipment locators help you today.