Eyeworld

MARCH 2021 | EYEWORLD | 45 C by Liz Hillman Editorial Co-Director About the physicians Arthur Cummings, MD Wellington Eye Clinic Dublin, Ireland Eric Donnenfeld, MD Ophthalmic Consultants of Long Island Garden City, New York Sumit "Sam" Garg, MD Gavin Herbert Eye Institute University of California, Irvine Irvine, California Cathleen McCabe, MD The Eye Associates Sarasota, Florida John Vukich, MD SSM Health Davis Duehr Dean Eye Care Madison, Wisconsin Dr. Donnenfeld discussed a combination of Vivity in one eye and PanOptix in the other giv- ing better spectacle-free near vision than Vivity alone and better clarity and distance vision than PanOptix alone. "If I want to have the best chance of having complete spectacle independence, PanOptix would still be the lens to choose," he said, not- ing that Vivity is better for patients who don't want to compromise distance vision in any way. Dr. Donnenfeld also mentioned iPure (BVI), which is a preloaded IOL that provides high contrast in low light and depth of field. Accord- ing to BVI's website, the lens is a monofocal that is designed to "maintain natural corneal depth of focus." The IC-8 (AcuFocus) and XtraFocus (Morch- er) are pinhole IOLs, currently approved for use outside the U.S. Dr. McCabe said she thinks this type of technology will be important to address aberrated corneas. "We don't have anything else to help in that area, which is why I think it's a unique solution for us in the future," she said. Adjustable IOLs The ability to adjust refraction postop, allowing patients to experience their vision for a time and change it, if necessary, before it's locked in is currently available in the U.S. with the Light Adjustable Lens (LAL, RxSight). Though it's been available for more than a year, John Vukich, MD, thinks there is still an education gap with this lens option. Arthur Cummings, MD, who has had expe- rience with Vivity since January 2020, said that the lens is uniquely forgiving. "Even if the lens is decentered significant- ly, you're not going to get glare and halo, and even if you're off target up to –1 in one eye, you're not going to get glare and halo," Dr. Cummings said, explaining that –0.5 to –0.75 of anisometropia seems to further extend depth of focus ability and functional near vision for the patient. Dr. Cummings thinks the forgiving nature of this lens will encourage more ophthalmologists who previously shied away from the presbyopia- correcting lens market to enter. "This lens will help grow the market," he said. "People who never before considered themselves to be refractive cataract surgeons are going to start using it." Other lenses not yet available in the U.S. are the Tecnis Synergy (Johnson & Johnson Vision) and LuxSmart (Bausch + Lomb). Syn- ergy (currently available in Europe, Australia, New Zealand, and Canada) is described as a continuous range of vision IOL that provides high-contrast vision even in low light. It has violet light-blocking technology to reduce halos. LuxSmart is a preloaded IOL that gives extend- ed depth of focus with violet filters. Another option, Tecnis Eyhance (Johnson & Johnson Vision), which recently became avail- able in the U.S., fits in the monofocal category. Sumit "Sam" Garg, MD, thinks the approach with Eyhance is interesting, though he thinks both Eyhance and Vivity will have dysphotopsias to some extent and, as before, the expectation for these should be set with the patient preoper- atively. (For more on Eyhance, see page 46.) Synergy, Dr. Garg said, mixes multifocal and extended depth of focus technologies, and he thinks it will do well overall. "It gives similar range, maybe better range, than a trifocal," he said. Eric Donnenfeld, MD, said that even though they're a year or two old now, PanOptix (Al- con) and Tecnis Symfony (Johnson & Johnson Vision) should be mentioned as well. "Symfony has a great range of vision with minimal distance problems," he said. continued on page 46 There has been quite a bit of movement in IOL innovations, some of which are available in the U.S., while others are still on the horizon.

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