This activity is produced by SLACK Incorporated and sponsored by Alcon Laboratories, Inc. Participating physicians are paid consultants of Alcon Laboratories, Inc.

Design Differences

How does the design of the AcrySof® IQ ReSTOR +2.5 D IOL with ACTIVEFOCUS design (Alcon Laboratories, Inc.) differ from that of the AcrySof® IQ ReSTOR +3.0 D IOL (Alcon Laboratories, Inc.)?
Anna F. Fakadej, MD, FACS, FAAO

Anna F. Fakadej, MD
Partner
Carolina Eye Associates
President
The Eye Surgery Center of the Carolinas
Southern Pines, NC

There are several ways that the design differs for these two IOLs. First, the ReSTOR +2.5 D IOL with ACTIVEFOCUS design has fewer concentric rings than the ReSTOR +3.0 D IOL. The contrast sensitivity was reported by patients to be better with the ReSTOR +2.5 D IOL with ACTIVEFOCUS design. Additionally, the center button is 100% dedicated to distance vision in the +2.5 D IOL,1 whereas the center button of the ReSTOR +3.0 D IOL is dedicated to near targets. For patients whose activities of daily living center around more near targets, the ReSTOR +3.0 D IOL would be a better choice.2 On the other hand, the ReSTOR +2.5 D IOL with ACTIVEFOCUS design is a better choice for patients who desire a broad range of vision with excellent distance vision and multifocality.

How does the AcrySof® IQ ReSTOR +2.5 D IOL with ACTIVEFOCUS design differ from other IOLs in terms of the amount of light allocated to the distance focal point at various pupil sizes?

The optic of the ReSTOR +2.5 D IOL with ACTIVEFOCUS design differs markedly from other presbyopia-correcting IOLs in that the center is dedicated to distance, the paracentral concentric rings provide intermediate distance vision in that the center and exterior portion are dedicated to distance, while the paracentral concentric rings provide intermediate vision.3 So, it varies with pupil size, with more light allocated to the distance focal point at every pupil size increase.3

The center button of the ReSTOR +2.5 D IOL obtains light entirely for distance, which helps patients have clarity at distance. Because 100% of the light is aimed at the retina, this implant offers excellent distance vision as well as good multifocality and a broad range of vision because of the paracentral rings.

When the pupil is extremely miotic, or small, the center button of the ReSTOR +2.5 D IOL with ACTIVEFOCUS design is the portion of the IOL that provides distance vision. This center button enables the IOL to offer better distance focus and maximize the distance vision in bright sunlight or brightly lit environments, when pupils are usually small. Distance in sunny circumstances is an important target for golfers, for example. However, pupil size varies in different lighting, which will vary the distance that the eye can focus and provide multifocality.

In other diffractive designs, a lesser percentage of light may be focused to the retina from distance, giving some patients “waxy” vision. With the ReSTOR +2.5 D IOL, my patients report sharp distance vision, because the central button is dedicated to the distance focal point, clarity is improved.4

How does the AcrySof® IQ ReSTOR +2.5 D IOL with ACTIVEFOCUS design differ from other IOLs in terms of the contrast sensitivity?

Most, if not all, other presbyopia-correcting IOLs have a near-point central button. On the other hand, the ReSTOR +2.5 D IOL with ACTIVEFOCUS design is designed with a distance-focused central button.

What does that translate to for patients? In bright light situations — again, for golfers and other outdoors enthusiasts — 100% of the light is targeted to the retina with the ReSTOR +2.5 D IOL. However, the pupil is not a fixed organ. It will move and vary with lighting and accommodation. The concentric rings that are paracentral to that central button will allow broad-range vision. This advanced design translates to less loss of contrast sensitivity.

Loss of contrast sensitivity has been problematic, particularly with the early presbyopia-correcting multifocal IOLs. More recent developments in optical engineering have improved contrast sensitivity issues. The ReSTOR +2.5 D IOL with ACTIVEFOCUS design accomplishes this by being the only multifocal IOL with a central portion solely dedicated to distance vision. This really sharpens contrast sensitivity, all while allowing patients the freedom and functionality of a broad range of vision without glasses for most daily activities.

What impact does the design of the AcrySof® IQ ReSTOR +2.5 D IOL with ACTIVEFOCUS design have on visual disturbances?

Historically, multifocal presbyopia-correcting IOLs have had issues with halos.4 These issues are not completely erased with any multifocal design, but with the ReSTOR +2.5 D IOL with ACTIVEFOCUS design, my patients are not reporting a lot of complaints about halos.

The ReSTOR +2.5 D IOL was built on the AcrySof platform, which is highly engineered and elegantly designed. Several design features of the AcrySof platform enhance the +2.5 D IOL with ACTIVEFOCUS design. For instance, the AcrySof platform is aspheric, and that is highly important for decreasing stroke aberration. Also, the edges of the AcrySof platform are squared. This helps to decrease posterior capsule fibrosis, which would impact a multifocal IOL more so than a monofocal IOL. The yellow chromophore of the AcrySof filters out blue light, which can also help with contrast sensitivity.

The ReSTOR +2.5 D IOL is the next generation of the multifocal lens. This lens has been elegantly designed to maximize distance vision while maintaining the functionality of near vision, which is important to patients.1

References

1. AcrySof® IQ ReSTOR +2.5 D Multifocal IOL Directions for Use. Alcon Laboratories, Inc.; Fort Worth, TX.

2. AcrySof® IQ ReSTOR® +3.0 D IOL Directions for Use. Alcon Laboratories, Inc.; Fort Worth, TX.

3. Alcon Laboratories, Inc., data on file. April 11, 2016.

4. Vega F, Alba-Bueno F, Millán MS, Varón C, Gil MA, Buil JA. Halo and through-focus performance of four diffractive multifocal intraocular lenses. Invest Ophthalmol Vis Sci. 2015;56(6):3967-3975.

Please see Important Product Information for AcrySof® IQ ReSTOR® IOLs for information on products in this activity. All trademarks and trade names belong to their respective owners.

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