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EW CATARACT 70 January 2017 Device focus by Michelle Dalton EyeWorld Contributing Writer effects such as glare and reduced contrast sensitivity," said Ehud Assia, MD, director, Department of Ophthalmology, and medical direc- tor, Meir Medical Center, Tel Aviv, Israel. "As more manufacturers are entering this field, the intermediate vision is definitely the most import- ant feature of these lenses. The loss of light is reduced more and more by using it in different orders. Still, there are some issues with contrast sensitivity and halos, but a lot less than with bifocal or multifocal IOLs. Well-informed patients know that they will be bothered for the first month, but this improves due to brain adaption up to 6 months after surgery," Dr. Mertens said. Comparing trifocal lenses Patients seem to prefer trifocal lenses more so than multifocal, these phy- sicians said, and trifocals compare favorably to other enhanced vision lenses as well. For instance, extended depth of focus lenses "are a com- pletely different aspect for refrac- tive cataract surgery, as they offer optimal distance acuity and contrast sensitivity and some improved inter- mediate VA," Dr. Kanellopoulos said. "Trifocal lenses may offer complete independence from spectacles at both distance and intermediate. Our 5-year experience in Europe is very positive. I can see making these lenses a mainstay surgical treatment globally and in the U.S." Trifocals outperform accom- modative, extended depth of focus, multifocal IOLs in general visual performance and regarding dys- photopsia, Dr. Cummings said. The lenses produce fewer higher order aberrations such as halo, Dr. Mertens added. Dr. Assia recently reviewed clinical results using PhysIOL trifocal IOLs and found that "90% had 6/9 uncorrected distance VA or better, 85% had 6/9 uncorrected interme- diate VA, and 95% had uncorrected near VA of J2 or better," he said. Toric trifocals showed similar results in astigmatic patients, Dr. Assia said. In comparison, in pa- tients implanted with the Tecnis Symfony extended depth of focus lenses (Abbott Medical Optics, Abbott Park, Illinois), uncorrected Trifocals outperforming other premium lenses continued on page 72 The FineVision trifocal lens Source: PhysIOL The AcrySof IQ PanOptix toric IOL Source: Alcon The AT LISA trifocal 839MP Source: Carl Zeiss Meditec Still not available in the U.S., European surgeons are beginning to prefer the technology over other premium lenses W hen multifocal lenses were first introduced, they were heralded as a means of pro- viding both near and distance vision improvements for patients undergoing cataract surgery. These IOLs feature two main foci, but patients continually demanded better intermediate vision. In today's world, one could argue intermediate vision is even more crucial than near for performing daily tasks such as using a computer, tablet, or smart- phone. Trifocal IOLs combine two diffractive profiles to improve vision across all spectrums, and published reports indicate high levels of both spectacle freedom and patient satisfaction. The technology has yet to be introduced in the U.S., but those familiar with the lenses are embracing the technology and think it offers patients the best potential visual outcome. "With trifocal IOLs, distance visual acuity (VA) is at least as good as a multifocal, intermediate VA is significantly better, and reading vision is slightly worse than a mul- tifocal's reading vision," said Arthur Cummings, MBChB, Wellington Eye Clinic, Dublin, Ireland. In Ireland, three trifocal lenses are approved and available: AT LISA (Carl Zeiss Meditec, Jena, Germany), FineVision (PhysIOL, Liege, Belgium), and PanOptix (Alcon, Fort Worth, Texas). For A. John Kanellopoulos, MD, LaserVision.gr Institute, Ath- ens, Greece, and clinical professor of ophthalmology, New York Univer- sity Medical College, New York, the primary driving force behind these lenses has been intermediate vision and quality of vision in lieu of contrast sensitivity in the refractive cataract patient. "In the U.S., there's been a step back from multifocal lenses and working with extended depth of focus. In Europe, though, there's a very large following with trifocal lenses," he said. Three technologies have been predominant in Europe: the FineVision, the AT LISA, and the PanOptix lens. In Belgium, in addition to those three lenses, the Alsafit (Alsanza, Pfullingen, Germany) and Acriva Reviol trifocal (VSY Biotechnology, Amsterdam, Netherlands) are also available, said Erik Mertens, MD, Medipolis, Antwerp, Belgium. The FineVision and AT LISA are also available in toric versions, and the PanOptix is expected to have a toric version shortly. Additionally, the second order light diffraction "is effectively utilized in trifocal lenses to provide intermediate vision, thus beside gaining an additional focus at the intermediate zone, there is less loss of defocused light and less side

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