Intraocular Lens Pipeline Yields Increasing Options

Pippa B. Wysong


January 26, 2016

Choosing the Right Intraocular Lens

Refractive surgeons have a wide variety of intraocular lenses (IOLs) to choose from when treating presbyopia, with more still currently in development. So how does an ophthalmologist sort through it all?

Sheraz Daya, MD, director of the Centre for Sight in London, United Kingdom, offered tips on the available options at the recent annual Walter Wright Symposium, held in Toronto, Ontario, Canada. He discussed four specific types of premium IOLs: accommodative, zonal refractive, trifocal diffractive, and extended depth of focus lenses.

With accommodative lenses, Dr Daya said, "the movement does not account for the full amount of 'accommodative power' that is sometimes seen. Some may be a pseudo-accommodation or multifocality of the optical system, or there may be arcing where the lens flexes and produces a phenomenal amount of power."

LENTIS® MPlus (Oculentis; Berlin, Germany) and SBL-3 (Lenstec; St Petersburg, Florida) are two of the newer zonal refractive lenses.

The MPlus acts like a bifocal lens, with two different focal areas, and is inserted through a 1.8-mm incision. Some patients complain that it can cause unsatisfactory near vision. Other patients reported difficulty driving because of headlight glare. However, Dr Daya pointed out that turning the lens upside-down offered a fix for that. The visual result is that patients see "headlights with a crown with no glare to the road, but they can actually drive," he said. Because of its asymmetric shape, it also can cause coma aberrations that affect vision quality. For these reasons, Dr Daya no longer uses the MPlus.

Dr Daya also mentioned that other zonal refractive lenses have zones in concentric circles, which cause considerable halos.

The story with trifocal diffractive lenses has been more favorable. The FineVision (PhysIOL; Liège, Belgium), the AT LISA® Tri Toric (Zeiss; Jena, Germany), and the new PanOptix® (Alcon; Fort Worth, Texas) lenses harness stray light to improve lens performance for near vision. FineVision is apodized with more energy for near vision in the lens' center; as a result, reading is "pupil-dependent." This helps reduce night-vision problems. Different lenses use different diffractive power and energy configurations.

The FineVision and AT LISA lenses are available in toric versions for astigmatism. The AT LISA lens is also bitoric, meaning that both the anterior and posterior surfaces are designed for astigmatism. Most toric lenses have the astigmatism surface on just one surface.

"We found that the trifocal toric lenses and trifocal lenses give very good outcomes in terms of distance, intermediate, and near vision. The vast majority of our patients are completely free of glasses," he said.

Lastly are the new extended depth of focus lenses, which include TECHNIS® Symfony (Abbott Medical Optics; Abbott Park, Illinois), WIOL-CF® (Medicem; Prague, Czech Republic), and AcrivaUD Reviol Tri-ED (VSY Biotechnology; Amsterdam, The Netherlands). These lenses provide continuous depth of vision but use slightly different approaches.

Dr Daya has had some patients complain of mild to moderate halos and vision-quality problems with the TECHNIS Symfony lens. Whereas patients generally have good intermediate and distance vision, not all obtain such results for near vision.

The WIOL-CF lens is novel in that it is delivered partially dehydrated and then expands inside the capsular bag from 7 mm (at insertion) to 9 mm. With this lens, "about 70% (of my patients) get 20/30 near vision—enough to read a newspaper. They find it tiring, but this gets better with time," Dr Daya said.

The AcrivaUD Reviol Tri-ED lens combines trifocal features with extended depth of focus. Initial studies[1] suggest it might have slightly better performance than other trifocal IOLs.

In his own practice, Dr Daya said he uses trifocal lenses "in 85% of all lensectomies and cataracts. The remaining 10% are the WIOL-CF or Crystalens (Bausch & Lomb; Rochester, New York), and only 5% have a monofocal lens."