Eyeworld

SUMMER 2025 | EYEWORLD | 35 R CHANGING MINDSETS by Liz Hillman Editorial Co-Director About the physicians Mark Gorovoy, MD Gorovoy M.D. Eye Specialists Fort Myers, Florida Yuri McKee, MD East Valley Ophthalmology Mesa, Arizona Gary Wortz, MD Commonwealth Eye Surgery Lexington, Kentucky H ydrophilic, hydrophobic, silicone, PMMA, collamer—there are many different types of IOL materials and, in the opinion of Yuri McKee, MD, "too little attention is paid to IOL material by surgeons." "Also, so much of what many surgeons know is from the marketing department of IOL manufacturing companies," Dr. McKee said in an email to EyeWorld. "Many surgeons find their favorite IOL and defend the use of the lens and the material. I enjoy not being bound to any one company so that I can choose the best IOL and material for each patient. In cases of unhappy patients who require an IOL exchange, I almost always end up changing the IOL material." Gary Wortz, MD, expressed the importance of having tempered comments in public forums against a material. "I think we have to remem- ber that medical decisions are made in the best interest of the patient always. It's hard to paint a technology with a wide brush, saying you should never do X, Y, or Z or should always do this, that, or the other," Dr. Wortz said. He also said there is no perfect lens material. "They all have their pros and cons, and I think all the materials that we're working with right now are great. If they weren't great, I think they wouldn't be FDA approved. We have the advantage of having a very strict FDA that puts materials and products through rigorous testing," he said. Hydrophobic acrylic Dr. McKee called this "the current king of IOL materials," due to its ubiquitous use among several IOL companies. Dr McKee said the high- er refractive index of the material allows for a thinner IOL and smaller incision sizes. "The simplicity, durability, small incision size, and common availability have made the single-piece hydrophobic acrylic IOL the most common IOL type in the U.S.," he said, noting downsides have been the square-edge design of some IOLs, which were thought to decrease PCO rates but have, in some cases, increased the risk of UGH syndrome and dysphotopsia. Dr. Wortz said hydrophobic acrylic IOLs have lower risk of PCO than hydrophilic acrylic IOLs, but he noted some issues with glistenings. "It's not all materials, but I think some of the hydrophobic acrylic materials may have a bit more propensity for negative dysphotopsias. The Abbe numbers are a bit on the lower end, and their index of refraction tends to be on the higher end, and that can cause negative dyspho- topsias and chromatic aberrations," he said. Dr. McKee said he now mostly uses hydro- phobic IOLs and avoids hydrophilic due to a high rate of IOL opacification in eyes with prior pars plana vitrectomy, uveitis, air injections, and other conditions. "The risk of long-term compli- cations is simply too high for my comfort with hydrophilic IOLs," he said. "I do not think this risk is avoidable, and I no longer consider IOLs of this material for implantation." Mark Gorovoy, MD, said he is opinioned in favor of hydrophobic IOLs. As a referral-based practice, many of which are for explantations, Dr. Gorovoy said he sees calcified hydrophilic lenses "very frequently," after secondary proce- dures such as tissue transplants or retinal issues. As such, he thinks hydrophilic lenses should be contraindicated, with hydrophobic lenses considered instead, for patients who might need an air bubble with DMEK or who have a history of retinal problems. Glistenings that have been associated with hydrophobic lens materials, such as the AcrySof platform (Alcon), Dr. Gorovoy said, have been replaced with a new hydrophobic Opinions on lens materials: hydrophobic, hydrophilic, silicone, and more continued on page 36 Hydrophilic IOL calcification Source: Mark Gorovoy, MD

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