Eyeworld

36 | EYEWORLD | SUMMER 2025 R EFRACTIVE material (Clareon, Alcon), which appears to be glistening-free. Dr. Gorovoy said time will tell if this material remains glistening free. On the topic of glistenings, Dr. McKee said the enVista platform (Bausch + Lomb) has "essen- tially eliminated glistenings in its hydrophobic material." "I don't see any downside of anyone getting a hydrophobic lens, especially with the newer materials," Dr. Gorovoy said. Hydrophilic acrylic Dr. Wortz said he has performed about 35,000 cataract surgeries, most of which have been with hydrophilic acrylic IOLs. "The thing I like about hydrophilic acrylic is I think it does have a lower index of refraction. It's a bit thicker, and even though it does tend to have a bit more PCO, I can deal with PCO with the YAG laser. I can't as easily deal with some of the other things like reflections or negative dysphotopsia with a YAG," he said. "If there's a problem that I can solve noninvasively, I think that's better. So hydrophilic is, in my opinion, equally as good of a material and in some ways better than hydrophobic, with one exception." This exception, he said, is a patient with Fuchs endothelial dystrophy who ends up need- ing a DMEK with an air bubble, which, as Dr. Gorovoy and Dr. McKee noted above, can lead to calcification and opacification of the lens. Dr. Wortz said he has only seen this a couple of times in his career. Dr. Gorovoy, in addition to not implanting hydrophilic lenses for risk of calcification, said he doesn't think they adhere as much to the capsule, which could lead to lens decentration or secondary cataracts. Positives of hydrophilic lenses, Dr. Gorovoy said, are that they can be inserted through a small incision, they open faster than hydrophobic lenses, and they're clear initially. Other materials Dr. Wortz called silicone the most biocompatible IOL material. He noted the lower risk of PCO and fibrosis with silicone but acknowledged the bad reputation the material might have gotten due to patients who later need a retinal attach- ment repair with silicone oil. He called these cases very rare. "I think it ended up creating a marketing problem around a very niche, real problem," Dr. Wortz said. "But I think silicone is a fantastic material. One of the more recently approved IOLs, the Light Adjustable Lens [LAL, RxSight], is made out of silicone." Dr. McKee called silicone one of his fa- vorite materials, which he said is versatile for sulcus or capsule placement. "It always comes in a 3-piece configuration, which I prefer. The rounded edges do not cause UGH syndrome and tend to reduce dysphotopsia," he said. Dr. McKee also acknowledged that this ma- terial should not be used in cases where silicone oil is present or likely to be used. There have been case reports of calcification of silicone IOLs in the setting of asteroid hyalosis with an open capsule, so he may avoid this IOL material in those cases as well. "I think the LAL is rekindling interest in sili- cone-based IOLs due to the outstanding refrac- tive results achievable with this adjustable IOL," Dr. McKee said. Dr. McKee also gave his thoughts on PMMA and collamer materials. For PMMA, he said they are generally well tolerated, have excellent optics, and remain clear for decades. Downsides he noted include rare reports of snowflake de- generation and the larger incision sizes required for these non-foldable lenses. Collamer, Dr. McKee continued, is also well tolerated with low adverse side effects. The phakic ICL (EVO, STAAR Surgical) is the only one currently using this material, but Dr. McKee said previously available STAAR collamer IOLs were "nice options" (excluding the polyimide haptic material, which is now known to degrade and shatter over time). continued from page 35 Calcified silicone IOL without any obvious cause Source: Mark Gorovoy, MD

• Cover