© 2021 MJH The Age of Life Sciences and Ophthalmology. all rights reserved.

© 2021 MJH Life Sciences™ and Ophthalmology Times. all rights reserved.

For the surgeon, the decision is more than just clarifying the patient's vision.

Reviewed by Neda Shamie, MD

The landscape of refractive cataract surgery has changed dramatically. Neda Shamie, MD, a partner at the Maloney-Shamie Vision Institute in Los Angeles, California, outlines the issues that need to be considered in modern surgery, including various IOL options.

She said that the attention of cataract surgeons to patients has gone beyond a clearer vision. Their goal now is to optimize vision and take into account the patient’s eye pathology, lifestyle, reading correction, previous refractive surgery, and comorbidities such as dry eye, age-related macular degeneration, and glaucoma, so that people can get rid of glasses Bondage.

This new method of refractive cataract surgery includes the possible use of high-quality IOLs, including Light Adjustable Lens (LAL; RxSight), trifocal IOLs (PanOptix, Alcon; Tecnis Synergy, Johnson & Johnson), and telephoto IOLs (Tecnis Symfony, Johnson & Johnson). Johnson; Vivity, Alcon), toroidal single focal plus IOL (Tecnis Eyhance Toric; Johnson) and toric single focal IOL.

Related: New presbyopia correction intraocular lens provides glasses independence

"These technologies allow for customized optimization of visual results," Shami said, explaining that in order to achieve optimization in her practice, she asked patients to tell stories about their vision and how they use their eyes throughout the day. This information facilitates the discussion and enables her to provide the best match between the advanced IOL technology available and the patient's eye health and vision needs. In contrast, explaining the various IOL technologies and their functions can confuse patients.

Lar. Shamie thinks this lens is very suitable for many of her patients. The intraocular lens can provide customizable vision shortly after implantation; it is fine-tuned to meet the needs of the patient and achieve adjustable monocular vision. With this kind of intraocular lens, there will be no refractive abnormalities, rotation of the toric intraocular lens, or reduced contrast. When adjusted to the result of slight myopia, this intraocular lens also provides some expanded focus.

Patients will need to use UV protective glasses; proper adjustments require an average of 3 visits to allow fine adjustments within 3 to 5 weeks after surgery. Using the updated version with ActivShield (RxSight), the results are more accurate and there is less concern about adhesion of UV protective glasses. Toric correction is limited to astigmatism less than 2 to 3 diopters.

Shamie said that she thinks LAL is an "excellent" addition to advanced IOL options. Many patients choose LAL's Mini Monocular, which provides extended depth of focus. She explained that the aiming distance of the dominant eye, the non-dominant eye diopter is about -0.75, the patient has a complete vision range, and the nighttime aberration is minimal or no. Perfectionist patients, who may be pilots or engineers, hope to get the best distance vision without compromising quality, and do not mind reading glasses. "For patients who want to optimize their vision without night glare and halos, LAL is a truly customizable option," she said.

Triple focal intraocular lens. Compared with the previous generation of multifocal intraocular lenses, this option can provide excellent uncorrected vision at all distances, reduce the need for glasses, reduce dependence on lighting conditions, and have much smaller night vision aberrations. However, some night glare and halos may appear, and diopter may need to be increased. People who want to see all distances without glasses and are willing to accept the possibility of slight glare and halos at night are suitable patients for this type of intraocular lens. "I really like to offer this option, and the results make the patient very happy," Shami said.

Related: Physicians comb the advantages and disadvantages of several new types of intraocular lenses on the market

Telephoto intraocular lens. This technology can provide an extended and smooth focus range from medium-distance vision to long-distance vision. It has a distance vision quality similar to that of a single focus, and it can increase the intermediate vision (length of the arm) without glasses. The patient still needs reading glasses, and may need to increase the diopter to optimize the visual effect.

Shamie corrects the non-dominant eye to a mini-single vision level of approximately –0.5 D, providing a slight extension of the extended focus. The aberration at night is minimal or no. "The patient is very satisfied with this intraocular lens, it is very tolerant of residual refractive errors or comorbidities," she explained.

Active infrequent readers, such as executives or computer users, believe that long-distance and middle-distance vision is important, and rarely read or work at close distances. For this group of patients, the best choice may be Vivity lenses with extended focal length or LAL with monocular vision.

Single focus intraocular lens. Eyhance (Johnson & Johnson) single-focal intraocular lenses (toric and non-toric) provide some extended focus, but are not extended focus IOLs. Shamie suggested that long-term monocular patients—for example, a 65-year-old myopic patient who used to use toric contact monoculars—using monocular toric intraocular lenses or titratable monocular LAL may achieve the best results .

Related: Presbyopia correction of intraocular lens improves patients' vision

Content-4.0D myopia may be the most challenging patient. He likes to work at close range without wearing glasses. I don’t know if my myopia is corrected, the uncorrected near focus will be lost. This patient has several good choices-a single-focal intraocular lens set for near vision, a three-focal intraocular lens for understanding weak near vision, or an LAL with a target of -2.0 D and a titration result is the best choice.

Shamie summarized the ideal situation when choosing an intraocular lens:

"Considering all of this, refractive cataract surgery is not only possible, but also makes patients feel happy," Shami concluded.

This article is adapted from a speech by Shamie at the 2021 Women in Ophthalmology Summer Symposium. She is a consultant and advisor to Alcon, Johnson & Johnson Vision and RxSight.