Eyeworld

EW REFRACTIVE 74 March 2017 by Michelle Stephenson EyeWorld Contributing Writer New adds offer new options P revious generations of multifocal IOLs (high add power) provided good quality near vision for reading. However, interme- diate and distance vision were not optimal, and many patients report- ed issues with glare and halos with these lenses. Recently, there has been a shift in patient preferences, with an increasing number of patients preferring intermediate distance for reading. This has occurred because, unlike previous generations, today's patients read at mid-range distanc- es because most reading is done on computers and smart phones. Patients are finding that their world now revolves around mid-range distances. "In the past, people read things very close up, and the earlier IOLs had very close reading adds that provided good reading vision. However, they really weren't suitable for computer vision at mid-range, and patients tended to have a small blank area in the mid-range that affected their ability to do many tasks," said Eric Donnenfeld, MD, Rockville Centre, New York. Concurrent with the shift in patient preference, new low add multifocal IOLs, which have stron- ger intermediate vision performance and seem to have less nighttime symptomatology, have entered the marketplace. "Fortunately, the advent of these low add multifocal IOLs times very well with the shift in the market preferences with a higher percentage of patients expressing a greater desire for intermediate performance and less concern for up-close book reading. The higher patient satisfaction rates we are seeing with these lower add multifo- cal lenses is invigorating the market. The three newer additions that we have are the ReSTOR 2.5 [Alcon, Fort Worth, Texas], the Tecnis 2.75 [Ab- bott Medical Optics, AMO, Abbott Park, Illinois], and the Symfony lens [AMO]," said Gary Foster, MD, Fort Collins, Colorado. He noted that the ReSTOR 2.5 has a higher percentage of light en- ergy directed to the distance image, so it is the most distance-dominant of any of the multifocal lenses. "I view this lens as having the best dis- tance performance with the fewest night symptoms, and it has accept- able intermediate performance. I view the Tecnis 2.75 as having the strongest intermediate performance of any of the available multifocal lenses, but it has a bit more night- time symptomatology and less light dedicated to distance vision than the ReSTOR 2.5. I tend to use this lens in people with very high precision intermediate needs. The Symfony has an extended range of focus and accounts for chromic aberrations, which allows a nice range of inter- mediate vision for patients. It also Era of multifocality F rom a patient's perspective, two of the most significant negative events in the aging process are centered on vision: presbyopia and cataracts. That is why when cataract patients are dealing with blurry vision and presbyopia, they appreciate learning their options to correct one (the cataract blur only) or both (the cataract blur and the presbyopia). I love the title of this article, "Era of Multifocality." Technically, perhaps the title should be "Era of Multifocality and Extended Depth of Focus" but that gets a little cumbersome. The reason I think we have entered the era of multifocality is because the big companies have put so much work and ingenuity into developing quality multifocal optics. These optics provide high patient satisfaction by providing the range of vision patients dream of while minimiz- ing negative side effects due to reduced contrast sensitivity. Ten years ago, multifocal implants were something I rarely used and now I use them in 40% of my cataract patients. Low add multifocals, which I define as a +3.25 diopter add or lower, and EDOF implants have changed the game. They provided for multiple powers to discuss with patients when trying to assess the optimal distance they would like for reading when they are all done. I appreciate the experts in this column, Eric Donnenfeld, MD, Gary Foster, MD, and Bryan Lee, MD, sharing their knowledge and experience with these exciting modern day premium implants. Vance Thompson, MD, Refractive editor The Symfony extended depth of focus IOL offers an additional technology for presbyopia correction. Here, the IOL's centration is confirmed by the Callisto (Zeiss) overlay. Source: Bryan Lee, MD The Symfony extended depth of focus IOL with diffractive rings Source: Eric Donnenfeld, MD Refractive editor's corner of the world

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