Eyeworld

94 | EYEWORLD | JULY 2021 R EFRACTIVE by Liz Hillman Editorial Co-Director About the physicians William Lahners, MD Center for Sight Sarasota, Florida Deepak Sobti, MD Texas Eye and Cataract Waxahachie, Texas Relevant disclosures Lahners: Johnson & Johnson Vision Sobti: None When using a near card with patients, Dr. Lahners said he shows them what they can expect with J5 to J6 vision with a Vivity lens, compared to J6 to J7 with Eyhance or, on the other end of the EDOF spectrum, J4 to J5 with the Symfony OptiBlue (Johnson & Johnson Vision). "This near vision conversation is quite a simplification of reality; some patients do a little better and some do a little worse, but at least it offers a way to compare the lenses," he said. "We do have a conversation about intermediate vision, but it is a little harder to quantify in the clinic like we can with a near card." As a non-diffractive lens, Dr. Lahners said Vivity has some advantages in terms of reduced night dysphotopsias that historically have been associated with diffractive EDOF lenses (though he noted that newer techniques have reduced these issues even in traditional diffractive lens- es). While Vivity might have a better contrast sensitivity and glare profile at night, "there is no free lunch in optics," Dr. Lahners said. "Because of our volumes, we have had sev- eral explantations of both Symfony and Vivity lenses for night dysphotopsias," he said, noting that they haven't explanted any Eyhance IOLs yet. The best patients for Eyhance and Vivity lenses, according to Dr. Lahners, are those who place primary importance on quality of vision (particularly night vision), even if it means wearing readers for fine print or heavy read- ing. While he wouldn't consider a patient with corneal irregularities, epiretinal membrane, or other ocular issues that could interfere with quality of vision for a diffractive EDOF lens, he said he has a bit more latitude with Vivity, but he's still cautious. "We have seen patients with severe night disturbances, even with Vivity. Generally, the best use of Symfony OptiBlue and Vivity is in eyes that are capable of high-quality vision. I think that the more the envelope is stretched, the less likely we are to make the patient happy," he said. "I use the Eyhance more like a monofocal and would be comfortable offering it to anyone capable of good quality vision." Dr. Sobti said he balances the goals of the patient with their risk tolerance in helping them decide on an IOL. The past several months have brought new ad- vances in IOL technologies available for use in the cataract and refractive surgeon's armamentarium. Understanding these new "ringless" EDOF IOLs can help us in fulfilling our patients' goal of spec- tacle independence without some of the shortfalls of previously available IOLs. In this YES Connect column, we further explore the topic of the newly FDA approved "ringless" EDOF IOLs with a focus on postop expectations, indications, and pearls from three experts. —Soroosh Behshad, MD, MPH YES Connect Co-Editor E nhanced monofocal and "ringless" EDOFs are a couple of the names floating around for a newer type of IOL designed to extend depth of focus while maintaining, as much as possible, the quality of distance vision provided by a monofo- cal IOL. There are a few new non-diffractive IOLs available in the U.S., Vivity (Alcon), Eyhance (Johnson & Johnson Vision), and RayOne EMV (Rayner). "This is a whole new category of lenses that offer increased quality of vision in patients who want to try to achieve more spectacle indepen- dence at near and intermediate ranges," said William Lahners, MD, who has experience with Vivity and Eyhance. With these lenses, Deepak Sobti, MD, put it, "we simply have more tools in our belt now to help patients achieve their goals." Dr. Sobti, who has experience with Eyhance, described the lens as having a slight central steepening that adds additional plus power and, therefore, some intermediate vision. Dr. Lahners pointed out that Eyhance, a mono- focal IOL with some additional intermediate vision and a little near vision, does not have presbyopia-correcting status from the FDA, whereas Vivity does, with more powerful near vision ranges, he said. "As a more powerful near lens, the Vivity does have more potential for mesopic and sco- topic dysphotopsia than Eyhance," Dr. Lahners said. A look at the latest 'ringless' IOLs that can extend depth of focus YES CONNECT Contact Lahners: wjlahners@centerforsight.net Sobti: info@TECeyecare.com

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