As bifocal IOLs become less popular in the United States and practically nonexistent overseas, trifocal and extended depth of focus lenses are becoming the go-to technology for refractive cataract surgery, with new lenses in development that will allow surgeons to improve on already impressive refractive target goals.
Eric D. Donnenfeld
Refractive cataract surgery is entering a new age as improving technology is allowing surgeons to hit refractive targets never before achievable. A surgeon’s ability to improve quality of vision with laser vision correction, the use of light adjustable lenses or lens indexing has changed the refractive cataract market, according to OSN Cornea/External Disease Board Member Eric D. Donnenfeld, MD, who presented on the topic at OSN New York 2019.
“There is an incredible demand by patients for a lens that provides spectacle freedom. This is an enormous unmet need right now, with only about 5% to 6% of patients receiving these types of lenses. As these types of lenses improve, I believe there will be dramatically more used in the future,” Donnenfeld said.
New generations of accommodating lenses, those designed on biomimetic principles that do not split light, are available outside the United States and may see FDA trials as early as this year. The Juvene lens (LensGen) is a capsule-filling, curvature-changing fluid-optic lens that relies on contraction of the ciliary muscle to shift fluid inside a silicone bag inside of the IOL to change the shape of the lens.
Donnenfeld said he participated in early trials of the lens, and most patients achieved reasonable accommodation, with a goal of 3 D. Donnenfeld implanted the first generation of the Juvene lens in the Dominican Republic 2 years ago and then implanted the most recent generation in Mexico last year.
“I implanted two generations, and I was able to see patients postoperatively who had the lenses and were functioning extremely well with distance and near vision at 1 and 2 years postoperatively,” he said.
Patients want quality of vision over everything else. Multifocal and EDOF IOLs have both dramatically improved quality of vision by reducing chromatic aberration and spherical aberration, reducing lost light and applying more light to distance vision, he said.
Trifocal lenses are popular in Europe, having mostly supplanted bifocal lenses. The AcrySof IQ PanOptix trifocal IOL (Alcon) is currently the only FDA-approved trifocal IOL available in the U.S. and offers true spectacle independence and high-quality vision, Donnenfeld said.
“You get reasonable distance vision and very little dysphotopsia. Reading under dim illumination has been a problem for some patients, but it’s a trade-off that we’re happy to make. ... The focus curve gives patients vision basically at all distances. There’s very high patient satisfaction with this lens,” he said.
The same caveats apply to the PanOptix IOL as to any presbyopic IOL. The lens should be avoided in irregular corneas and macular pathology, he said. Zeiss and Bausch + Lomb are currently developing trifocal IOLs for use in the U.S. market as well, he said.
A variety of IOLs in the pipeline could make it to the U.S. market in the next several years. The Tecnis Symfony Plus IOL (Johnson & Johnson Vision) provides an additional 0.5 D of near vision without any loss of distance quality of vision when compared with the Tecnis Symfony IOL (Johnson & Johnson Vision) and should be available this year, he said. The Tecnis Synergy IOL (Johnson & Johnson Vision), a combination EDOF multifocal lens, designed to provide true near vision and high-quality overall vision, will likely be available in 2021, Donnenfeld said. True accommodating lenses, however, may not be available to the public for the next 5 years. – by Robert Linnehan
- Donnenfeld ED. Next generation presbyopia-correcting IOLs. Presented at: OSN New York 2019; Nov. 15-17, 2019; New York.
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- Eric D. Donnenfeld, MD, can be reached at email: firstname.lastname@example.org.
Disclosure: Donnenfeld reports he is a consultant for Alcon, Bausch + Lomb, Johnson & Johnson, LensGen and Zeiss.