COMMENTARY

Up-and-Coming IOLs

European Society of Cataract & Refractive Surgeons (ESCRS) 2014

Roger F. Steinert, MD

Disclosures

October 28, 2014

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Hi. I am Dr Roger Steinert, chair of ophthalmology and director of the Gavin Herbert Eye Institute at the University of California at Irvine. I would like to share some interesting news from the recent European Society of Cataract & Refractive Surgeons (ESCRS) meeting in London, emphasizing technology that will make it to the United States in the near future.

The ESCRS meeting rotates around the major cities in Europe. We have a chance to see technology that is not yet available in the United States because the barrier set by the US Food and Drug Administration for safety and efficacy is much higher than it is in other parts of the world. In the European Union, for example, to receive a CE [European Conformity] mark, safety must be demonstrated, but fewer data are required on efficacy. They let the market and the physicians sort that out.

I want to emphasize the upcoming series of new intraocular lenses (IOLs) for presbyopia and increased range of vision. This is the tip of the iceberg, because all of the IOL companies are headed down this road and will be releasing models in the not-too-distant future. The European market is going to be the first, although the United States won't be very far behind.

The first of these IOLs may be the lens from Hoya (Hoya Surgical Optics, Singapore). They are introducing an extended depth-of-focus lens that is based on spherical aberration to give some increased depth of field. For this to be useful for reading, even arm's-length reading, it will also require binocularity with a mini-monovision approach. I have not seen the detailed data on how much depth of field these lenses will achieve, nor do I have any experience on what price must be paid for increased spherical aberration in terms of the impact on contrast sensitivity, quality of vision at night, or what happens with a larger pupil when the aberrations could become more prominent. Time will tell, but if Hoya does release that lens in the United States in the near future, we will get a chance to use it and find out. This approach may finally unlock the expansion of the presbyopia-correcting IOL market, which has been flat in terms of market penetration in the United States, at about 5%-6%, for several years.

With respect to the second lens that I want to speak about, I have to disclose that I am a consultant for Abbott Medical Optics. In Europe, they just released a lens with the name Symfony. It is a single-element lens that has what is called an echelette in the center, which gives a significant range of focus. It's not based on spherical aberration. One lens would certainly give enough depth of focus to go from distance to being able to read on a cell phone, if you wanted to have detailed vision up close for more extended reading. Again, perhaps, surgeons will gravitate toward a mini-monovision approach. In the United States, they will be released as spherical lenses. In Europe, they have already been released as both spherical and toric lenses. We hope that this won't be too far behind in the United States, because it will greatly increase the appeal of these lenses.

The advantage of these lenses is that, in the laboratory studies using simulations (eg, Air Force target resolution), the clinical experience in the studies that led to the lens being approved in Europe, and the clinical studies so far in the United States, they show a dramatic minimization of complaints of nighttime halo or glare or loss of contrast sensitivity, compared with a good, high-quality monofocal lens. This is a very exciting improvement in technology that could go a long way toward having surgeons who are concerned about the side effects of multifocal lenses take a second look at these extended–range of vision lenses.

I am confident that we are going to see many more choices from other lens manufacturers as well. This will all be wonderful news for the benefit of our patients and the choices that we can offer them with improved function at a lower cost, in terms of loss of contrast sensitivity or increase in such side effects as halo and glare.

This is a brief summary of the single most exciting news from ESCRS that is going to have an impact on the American ophthalmology market in the near future. Stay tuned for more. On behalf of Medscape, I'm Dr Roger Steinert.

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