Eyeworld

I DECEMBER 2019 | EYEWORLD | 41 international col- leagues, really pro- vides a nice range of vision where people are able to see their computers and read without needing to be dependent on glasses," Dr. Solo- mon said. Dr. Cionni offered a similar point, saying that the same IOL model can be implanted in both eyes, improving results and making the preop discussion easier for the surgeon and more understandable for the patient. Dysphotopsias, Dr. Yeu said, seem to be a lesser concern with the PanOptix trifocal technology, particularly because the overall range and quality of vision are excellent. She said it's more of a ring-like halo, rather than streaking or starbursts, so it's easier to describe to patients. Considering candidates A healthy macula and ocular surface are key for success with these lenses, the sources said. Dr. Yeu said she is still relatively stringent in select- ing patients for PanOptix. She is not currently offering this lens to patients who have had prior refractive surgery because, she said, she's in an early phase of using the technology. Dr. Solomon had used PanOptix in one post-LASIK patient who was 2-weeks postop and doing well when EyeWorld spoke with him. While patients with prior refractive surgery were excluded from the FDA clinical trial and histor- ically many U.S. surgeons have shied away from using multifocal lenses in these patients, he said the clinical experience in the U.S. with EDOF lenses and trifocals overseas in post-refractive patients is such that he felt confident doing so in a patient who didn't have irregularities with their vision. technology coming to the U.S. Significance of trifocals Dr. Donnenfeld said the availability of trifocal lenses in the U.S. is important because it offers a different type of vision, a different option to patients. "What we have in the U.S. are wonderful lenses that give great vision at distance, but not as good close up, and those include extended depth of focus (EDOF) and low-add multifo- cals," Dr. Donnenfeld said, adding that patients might have the expectation that they wouldn't need glasses for reading with these lenses and, as such, ophthalmologists have been "com- promising our offerings to these patients" by offering high-add multifocals at the cost of distance vision with more glare and halo, mixing and matching lenses, and employing other techniques to enhance vision with available technologies. "Trifocals give you the same reading that the high-add multifocals have, but it also gives you intermediate vision, and in my experience and international experience, they give better distance vision," Dr. Donnenfeld, who has just been adding trifocals to his practice, said. "It really fills areas that are needed for presbyopia correction and that is intermediate vision and good quality of vision at distance." Dr. Solomon said he thinks trifocals bring a more full range of vision to the market. He also said it simplifies things. Before, he said, there would need to be conversations with the patients to determine what they wanted out of their lens—intermediate (computer/cellphone) vision or near (reading) vision—with compro- mises on one or the other. "What the trifocal brings is the opportunity to really simplify the discussion. Do you want to be able to see distance and near? The trifocal, according to the U.S. data and speaking to our About the doctors Robert Cionni, MD Medical director The Eye Institute of Utah Salt Lake City Eric Donnenfeld, MD Ophthalmic Consultants of Long Island Clinical professor of opthalmology New York University Garden City, New York Kerry Solomon, MD Carolina Eyecare Physicians Mount Pleasant, South Carolina Elizabeth Yeu, MD Assistant professor of ophthalmology Eastern Virginia Medical School Virginia Eye Consultants Norfolk, Virginia continued on page 42 "….thus far, the patients in whom we've implanted this IOL since approval are thrilled with their results." —Robert Cionni, MD

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