Eyeworld

MARCH 2020 | EYEWORLD | 43 C by Rich Daly Contributing Writer (Alcon) in 2019 brought another option to the U.S. market that provides a range of vision. In Dr. Yeu's experience with PanOptix, it has a similarly forgiving defocus curve with "a nice range of vision where there is no real break but with the benefit of having the added near [vision] at 40 centimeters," Dr. Yeu said. "I'm able to give my patients that reading vision out to distance, which has helped to simplify the conversation." Thomas Clinch, MD, has found EDOF lenses provide distance vision almost immedi- ately, functional intermediate vision within a week, and improving near vision over 3 months. However, Dr. Clinch said most patients require over the counter readers for near tasks, such as fine print reading. In contrast, the trifocal IOL provides patients with good functioning at all distances within 2 weeks, Dr. Clinch said. Choosing lenses Although Dr. Yeu is weighing patient experi- ences to drive her IOL recommendations, for most patients with healthy corneas looking for a range of vision, she leans toward the trifocal lens at this time because of the fuller range of vision provided binocularly. However, she recommends EDOF lenses for post-LASIK or RK patients and A s surgeons gain experience with ex- tended depth of focus (EDOF) and trifocal IOLs, they are increasingly identifying patient types who have better visual outcomes with each. Elizabeth Yeu, MD, has used the TECNIS Symfony EDOF IOL (Johnson & Johnson Vision) since early after its FDA approval and has long used a modified personal approach, which places the Symfony or Symfony toric IOL in the dominant eye and a multifocal in the non-dominant eye. "Patients have high-quality vision with that combination," Dr. Yeu said. Compared to multifocal lenses, she found the first-generation EDOF lenses provided her patients with "an extra quality of vision most notable by the fact that little blips did not cause a dramatic loss in satisfaction with the patient's vision." For example, when patients had small amounts of residual dry eye or astigmatism, vision was not drastically adversely affected. Dr. Yeu emphasized the need for ensuring prospective EDOF lens patients have healthy ocular surfaces, or at least ones that respond well to treatment, but she has noticed that patients can experience less degradation to their quality of vision with postop dry eye issues. The biggest complaint of the first-gen- eration EDOF IOLs was that they provided insufficient reading vision at near. "Over time if you offset it or blend it with a multifocal lens implant, you can get more reading vision," Dr. Yeu said. The distance to computer vision range of the Symfony required development of a specific patient instruction package to underscore its vision parameters. "Even if we say it verbally, once patients are finished with surgery, they don't remember that," Dr. Yeu said. "They expect to be able to read and see distance, especially if they are paying additionally out-of-pocket for that type of technology." Enter the trifocal option The FDA approval of the PanOptix trifocal Clinical experiences shape EDOF and trifocal IOL use continued on page 44 About the doctors Elizabeth Yeu, MD Assistant professor Department of Ophthalmology Eastern Virginia Medical School Norfolk, Virginia Thomas Clinch, MD Clinical professor Department of Ophthalmology Georgetown University Washington, D.C. Relevant disclosures Yeu: Alcon, Bausch + Lomb, Beaver-Visitec International, Carl Zeiss Meditec, Johnson & Johnson Vision Clinch: Alcon, Johnson & Johnson Vision Contact Yeu: eyeulin@gmail.com Clinch: tclinch@edow.com "I will work with them to try to choose the appropriate IOL for their individual needs, but it is impossible to be 100% correct in predicting how their brain will process the information." —Thomas Clinch, MD DEVICE FOCUS

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