Eyeworld

113 EW FEATURE March 2015 Refractive options by Vanessa Caceres EyeWorld Contributing Writer "I am so impressed by the enthusi- asm of the surgeons who have used this lens. This offers the option of micro monovision, giving patients an excellent range of vision without true monovision or other significant visual compromise," he said. As with any IOL, patients need to meet their refractive targets, and surgeons need to control for astig- matism, Dr. Donnenfeld said. Still, the lens has a built-in advantage for surgeons. "If you're off by half a di- opter, you can still get 20/20 vision because you're in that sweet spot of 2 diopters. So, if you're off a little refractively, there aren't significant refractive concerns like with a multi- focal IOL," he said. Another advantage of the lens for surgeons is that there is no change to the existing surgical technique that they use for IOLs, Dr. Donnenfeld said. "My impression is the same as physicians internationally. Patients are enjoying the lens with minimal refractive com- plaints," Dr. Donnenfeld said. EW Editors' note: Dr. Donnenfeld has financial interests with Alcon (Fort Worth, Texas) and Bausch + Lomb (Bridgewater, N.J.). Dr. Holladay has financial interests with the Holladay IOL Consultant, Alcon, and AMO. Dr. Koch has financial interests with Alcon, AMO, and Ziemer (Port, Switzerland). Contact information Donnenfeld: ericdonnenfeld@gmail.com Holladay: holladay@docholladay.com Koch: dkoch@bcm.edu Extended depth of focus, extended range of vision lenses provide advantages for presbyopia patients, await more studies in the U.S. and abroad A s surgeons continually aim to boost refractive outcomes, some think that extended depth of focus and the first extend- ed range of vision IOLs, all available outside of the U.S. at this time, may be the right fit for presbyopic patients who want refractive cataract surgery. The design of extended depth of focus IOLs appears to improve on any downfalls associated with multifocal IOLs. "The lenses redistribute the rays from a singular focus in a monofocal IOL to a range of foci, minimally affecting the peak resolution, or best focus," said Jack T. Holladay, MD, MSEE, clinical professor of ophthal- mology, Baylor College of Medicine, Houston. "Without being a true multifo- cal IOL, [extended depth of focus lenses] extend the focal point out through various mechanisms," said Douglas D. Koch, MD, professor and the Allen, Mosbacher, and Law chair in ophthalmology, Cullen Eye Institute, Baylor College of Medi- cine. "One mechanism is to create some form of spherical aberration that increases depth of focus. The second is a little extension of mul- tifocality but with compensation of chromatic aberration. By doing this, it increases clarity and depth of focus." "The new class has one focal point, but it's spread over a long area so there's a broad focus over ap- proximately 2 diopters," said Eric D. Donnenfeld, MD, clinical professor of ophthalmology, New York Univer- sity Medical Center, New York. Dr. Donnenfeld is involved with U.S. Food and Drug Administration (FDA) clinical trials of the Tecnis Symfony (Abbott Medical Optics, AMO, Abbott Park, Ill.), the extend- ed range of vision lens available for patients with or without astig- matism. Although the lens can be implanted unilaterally or bilaterally, the FDA trial is using bilateral im- plantation. Currently, extended depth of fo- cus and the extended range of vision IOLs are used in Europe and around the world, Dr. Donnenfeld said. The FDA trials are in process, and it may be about a year and a half before the Symfony lens is approved in the U.S., he estimated. For more information about European results of this lens and how it differs from extended depth of focus technology, see "New lens solves problems of presbyopia-correcting IOLs" on page 100 in this issue of EyeWorld. Lenses that employ extended depth of focus technology include the Mplus (Oculentis, Berlin), Mini Well (Sifi MedTech, Aci Sant'Anto- nio, Italy), a lens in development from Hoya (Chino Hills, Calif.), and the IC-8 IOL (AcuFocus, Irvine, Calif.). Glare, halos, contrast sensitivity One advantage seen so far with the technology of these lenses is that they do not have the same glare and halos associated with multifocal IOLs. "There is minimal glare and halo, equivalent to that with a monofocal lenses," Dr. Donnenfeld said, citing data from an AMO Symfony study. There does appear to be some loss of contrast sensitivity, but this seems to bother patients less due to the lack of halos and glare, Dr. Donnenfeld said. "The Symfony lens that I work with has a chromatic aberration that compensates for contrast sensitivity, so patients don't seem to see or feel a difference," he said. There are emerging studies about extended depth of focus and extended range of vision IOLs com- pared with other IOL types. "Data presented at the 2014 European Society of Cataract & Re- fractive Surgeons meeting in London showed that the bilaterally implant- ed Tecnis monofocal exhibited 1.5 D of defocus and maintained 20/40 or better visual acuity, whereas the Tecnis Symfony showed 2.5 D and maintained 20/40 or better, ap- proximately 1 D extended depth of focus," Dr. Holladay said. Advantages, caveats Dr. Koch would like to see peer-re- viewed study data to substantiate the results from the AMO studies. Nonetheless, he is excited about the possibilities with these technologies. New tools in the cataract surgeon's toolbox AT A GLANCE • Extended depth of focus and extended range of vision IOLs are a newer type of IOL that extend the focal point of the lens. They are designed for cataract surgery patients who have presbyopia. • These lenses are used in Europe and around the world but have not yet received approval in the U.S. • Study results so far show that glare and halos are equivalent to monofocal IOLs. The Tecnis Symfony has an elongated focal point, giving the wearer a continuous, full range of vision. Although the lens has diffractive gradings, it creates only 1 image on the retina, not the 2 images characteristic of multifocal IOLs. Source: Abbott Medical Optics

• Cover