Eyeworld

EW CATARACT 28 January 2019 A patient with the Tecnis Symfony IOL Source: Viral Juthani, MD There was little in the literature on this because the technology is so new but investigators did manage to find one large trial 2 by the Concerto Study Group, which included 411 patients who underwent bilateral implantation of the Symfony lens. The study included two groups, one in which micro-monovision was the aim in the non-dominant eye and the other in which emmetropia was the target. "They found that using micro-monovision improved inde- pendence and patient satisfaction," Dr. Juthani said. "About 14% of pa- tients required spectacles postopera- tively. While generally 10% or fewer of those with multifocal lenses need spectacles after implantation, the side effect profile with the Symfony lens was slightly improved with the EDOF lens." The main disadvantage of these lenses compared to the multifocals is the quality of the uncorrected near vision, especially at the 12- to 14-inch distance, he explained, adding that it's the nature of these lenses. "The longer you create the focal plane to be, the more blurring you get in that range," he said. Dr. Juthani finds that the Sym- fony lens is best suited for those with little or no astigmatism, who have otherwise healthy eyes and an active lifestyle. "Also, taller individ- uals who tend to have longer arms— and because of that have a longer working distance—might enjoy these more than people who have shorter arms and are holding a book closer to their face," he said. Other EDOF lenses rely on different technology. Dr. Juthani pointed to the small aperture lenses, which work by the pinhole effect, blocking unfocused rays of light that can degrade the image quality. These include the IC-8 lens (Acu- Focus, Irvine, California) and the XtraFocus pinhole implant (Morch- er, Stuttgart, Germany). Such lenses are not available in the United States and the data available on them are limited. "The application seems greatest in patients who have slightly greater amounts of astigma- tism and other higher order corneal aberrations," Dr. Juthani said. Another approach is with a multifocal aspheric lens, such as the Mini Well Ready (SIFI Medtech, Catania, Italy), the first progressive aspheric intraocular lens, avail- able in Europe, Dr. Juthani noted. "Instead of having discreet steps for correcting distance, intermediate, and near, it has more of a blended optic," he said. "It's similar to hav- ing a progressive lens in the eye." While he finds that the initial re- sults for this type of lens look good, there's a need for longer and more formal prospective studies, he said. In Dr. Juthani's view, EDOF lenses are a valuable addition to the presbyopic armamentarium. "I think there is a group of patients who will be happy with these lenses, and we have to have the right conversations with people to determine what works best for them," he said. Going forward, he pointed out that there will be some new trials looking at a combination of EDOF lenses in one eye and either a multifocal or a trifocal lens in the other. "It will be interesting to see what these formal studies show," he concluded. EW References 1. Akella SS, Juthani VV. Extended depth of focus intraocular lenses for presbyopia. Curr Opin Ophthalmol. 2018;29:318–322. 2. Cochener B, et al. Clinical outcomes of a new extended range of vision intraocular lens: international multicenter Concerto Study. J Cataract Refract Surg. 2016:42:1268–1275. Editors' note: Dr. Juthani has no finan- cial interests related to his comments. Contact information Juthani: VIRJUTH@montrfiore.org Close-up continued from page 27

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