Eyeworld

World view The right IOL for the physician and the patient O ver the years, cataract surgical technological advancements have been tremendous, streamlining the surgery itself to increase efficiency and patient outcomes. In many ways, intraocular lens (IOL) devel- opment has followed suit, with improving materials, optimizing optics, and trying to provide a range of vision. But has it been enough? Have we hit a plateau, or are we going to see even better choices for our pa- tients and better outcomes? In this issue of EyeWorld we delve into current and future IOL choices. With respect to the current state of IOLs, we hear opinions from Douglas Koch, MD, Jonathan Rubenstein, MD, and Kevin Miller, MD, about IOL materials, chromatic aberrations, and the advantages and disadvantages associated with certain IOLs. They also delve into the range of powers available, the delivery systems, and how there could be room for improvement. Elizabeth Yeu, MD, Richard Lindstrom, MD, and Robert Wein- stock, MD, discuss the currently available accommodative IOLs and what is coming down the pipeline. They also review who may be a good candidate for these IOLs. With respect to multifocal IOLs (MFIOLs), we ask Dr. Yeu and Tal Raviv, MD, where they stand. They discuss lower add MFIOLs and extended depth of focus (EDOF) IOLs, as well as who is best suited for them. Kendall Donaldson, MD, Eric Donnenfeld, MD, and Uday Devgan, MD, discuss the niche for EDOF IOLs, including which patients are the best candidates and what this type of IOL has to offer. They address questions like should it be used in blended vision scenarios or is mini-monovision better? Richard Lindstrom, MD, Samuel Masket, MD, and Dr. Devgan provide their insights into the range of "futuristic" IOLs. Important aspects include reducing aberrations, improving presbyopic correc- tion, and the need for postoperative adjustability. They delve into tackling the current design flaws and beyond. Using toric IOLs to correct astigmatism has been an option for awhile. Michael Greenwood, MD, Russell Swan, MD, Edward Holland, MD, and Lawrence Woodard, MD, share their thoughts on how to optimize use of these IOLs. They review current toric IOLs available and look at specific cases such as high corneal cylinder cas- es, toric versus a corneal approach for astigmatism management, and when not to implant a toric IOL. I think the most important question is whether we will ever have the "perfect" IOL. Perfection lies in the "eye" of the beholder. Each new lens material and design works toward mimicking the natural lens, or at least some of its properties. Each design draws us closer to better outcomes for our patients. We will continue to move forward to optimize vision and minimize side effects. EW Rosa Braga-Mele, MD, Cataract editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S March 2018 Vol. 23 • No. 3 Publisher Donald Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Michelle Stephenson Roanoke, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 Fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Paul Zelin paul@eyeworld.org Monica Frishman monica@eyeworld.org Classified Sales Cathy Stern cathy@eyeworld.org EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org Anne Le anne@eyeworld.org ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. 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