Josh Johnston, OD, FAAO, evaluates the nuances integral to success with new technology for premium cataract surgery. He is the clinical and residency director at Georgia Eye Partners in Atlanta. Johnston reports he is a consultant to Alcon, Allergan, Bio-Tissue, Johnson & Johnson Vision and Shire.

BLOG: IOL state of the union

In this column, I continue to review and highlight current and emerging trends in cataract surgery.

Improvements in IOL technology — particularly trifocal and extended-depth-of focus options — are top of mind as cataract surgery moves ever closer to truly correcting presbyopia and providing patients with crisp, youthful (spectacle-free) vision at all distances.

Intermediate distance

With increasing use of smartphones, tablets and laptops, intermediate vision has become more important to patients, and extended-depth-of-focus (EDOF) IOLs seek to better meet this demand. Unlike traditional multifocal IOLs, which generate two or more separate focal points for defined viewing distances, EDOF lenses provide a single, elongated focal point with an increased depth of focus. The design is associated with potentially less negative impact on quality of vision compared to traditional multifocal lenses. Having a larger “sweet spot,” they also place less demand on the surgeon to achieve emmetropia.

In the U.S., the Tecnis Symfony IOL (Johnson & Johnson Vision) represents the first of these lenses to be FDA-approved. The implant employs a biconvex wavefront-designed anterior aspheric surface and a posterior achromatic diffractive surface with an echelette design. This proprietary format creates an achromatic diffractive pattern elongating to a single focal point and compensating for the chromatic aberration of the cornea.

Make it personal

Another example of a wider range of vision implant is the trifocal. These lenses combine two diffractive profiles to improve the spectrum of spectacle freedom. Many experts are optimistic that this technology, not yet available in the U.S., offers excellent potential for visual outcomes. The FineVision IOL (PhysIOL) was the first to become available in Europe.

Different trifocal and EDOF designs rely on varying mechanisms, including use of achromatic IOL technology, zones with different aspheric profiles and the pinhole effect. Trifocal and EDOF lenses also come with toric correction enabling surgeons to further give patients the best possible uncorrected distance visual acuity.

With the availability of the wide range of Tecnis Symfony toric lenses, for example, surgeons can achieve more personalized vision. Depending on patients’ preferences and visual needs, a “mix and match” approach using the full portfolio of available technology enables fully personalized cataract outcomes.

On the horizon

Many experts say that true accommodative design strategies for IOL technology still have not been perfected. Those that rely on shape-related changes in the surfaces of the implant or dynamic changes to the refractive index may be coming to the forefront. Fluid-optic accommodating IOLs (eg, Juvene by LensGen and FluidVision by PowerVision), are being investigated in trials outside the U.S. and in early clinical work.