Eyeworld

6 | SUPPLEMENT TO EYEWORLD SEPTEMBER 2021 STEP FORWARD INTO THE NEXT GENERATION OF CATARACT SURGERY Step forward with presbyopia-mitigating IOLs R ecent advances in IOL technol- ogy with significantly improved optics, increased depth of focus, and reliable results have helped create an entire field of advanced re- fractive cataract surgery that, according to Neda Shamie, MD, allows surgeons to offer patients results that address their individual lifestyles and visual expectations. Among these advances are the AcrySof ® IQ PanOptix ® Trifocal IOL (Alcon) and the AcrySof ® IQ Vivity TM IOL (Alcon), both of which are available as torics. PanOptix ® was FDA approved in 2019, becoming the first trifocal IOL in the U.S. Vivity TM was approved in 2020 and launched commercially in early 2021 as the first non-diffractive extended depth of focus IOL. The results Dr. Shamie said she's garnered with PanOptix ® and Vivity TM so far have her and her team offering them to patients and endorsing them to referring doctors "far more enthusi- astically than we ever did before [with other premium lens options.]" Perspectives on PanOptix® If a patient desires as much freedom from glasses as possible and is willing to trade off for some mild nighttime visual aberrations, PanOptix ® is the way to go, according to Dr. Shamie. "The PanOptix ® with its trifocal ca- pabilities has simplified our discussion in educating patients about multifocal benefits because we don't need to ex- plain the amount of add power, mixing and matching IOLs, or deficiencies at one depth of focus over the other," she said. "I have found that the PanOptix ® offers great vision at every functional distance (driving, computer, and read- ing) with less dependence on glasses. Our confidence in these lens options, the lessened chair time, the exception- al results, and, in turn, the happier patients have all contributed to our improved conversion rates to premium lenses." Surgeons need to be aware of comorbidities that could reduce success with these lenses, such as epiretinal membrane, significant ocular surface disease, and other factors that could compromise their optical system. Dr. Shamie said she does not offer PanOptix ® to these patients, and she is hesitant to offer it to a patient with mild cataract or early cortical changes. The Neda Shamie, MD "If you have hesitated to implant presbyopia- mitigating IOLs up to now … these IOLs are a great option and can offer a successful transition to expand your surgical armamentarium." —Neda Shamie, MD mild glare that could be induced may be significant enough to be perceived by the patient who upon presentation may be only mildly symptomatic from their cataract. "Such a patient may have a high level of sensitivity to visual aberration and may not be able to tolerate the nighttime halos some experience with the trifocal," Dr. Shamie explained. "This type of patient would be a candidate for the Vivity TM lens and be considered for a mini-mono to extend the depth of focus such that reading vi- sion could possibly be achieved without glasses." Valuing Vivity TM The situations where a trifocal might not be the best option is where Vivity TM can step in. "The Vivity TM IOL, with its mono- focal-like quality of vision, is filling the gap for those patients who may not be deemed a strong candidate for diffractive multifocal IOLs due to ocular comorbidities (i.e., epiretinal mem- brane) and is allowing us to offer them an option that gives depth of focus," Dr. Shamie said. "This is true for patients who would like a monofocal-like visual disturbance profile with less dependen- cy on glasses.

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