EDOF and trifocal lenses

Multifocal IOLs offer greater choice for patients

Dermot McGrath

Posted: Wednesday, November 21, 2018

Gerd Auffarth MD

The latest range of multifocal intraocular lenses, both extended depth-of-focus (EDOF) lenses and trifocal IOLs, deliver excellent quality of vision with very few of the visual disturbances that hampered the uptake of first-generation multifocal IOLs, delegates attending the World Ophthalmology Congress in Barcelona were told.

At a debate comparing the benefits and drawbacks of EDOF lenses versus trifocal IOLS, both Gerd Auffarth MD, PhD, and Ahmed El-Massry MD, PhD, agreed that technological advances have largely eliminated problems such as halos and glare that gave multifocal IOLs such a chequered reputation.

“If we were having this debate 10 or 15 years ago, we would probably be discussing the merits of monofocal versus multifocal IOLs, said Dr Auffarth, who presented the case for EDOF lenses.

“At the time, multifocal lenses essentially meant bifocals with all the known side-effects in terms of glare, halos and loss of contrast sensitivity. This image has stuck with multifocal IOLs and impeded their adoption, but I think it is a positive sign that we are now having a debate about different types of multifocal IOLs and how they can benefit our patients,” he added.

“I think the positive aspect is that we now have more choice for our patients,” agreed Dr El-Massry, Professor of Ophthalmology at Alexandria University, Egypt, who presented arguments in favour of trifocal lenses.

“For patients above 45 or 50 years of age with a clear lens I prefer to select an EDOF IOL because this will not compromise their contrast sensitivity for night driving. However, for the majority of my cataract patients my personal preference is to use trifocal lenses because they benefit more from the excellent near vision and reading ability that these IOLs offer,” he said.

Dr Auffarth, Professor and Chairman of the Department of Ophthalmology at the University of Heidelberg and Director of the David J. Apple International Laboratory of Ocular Pathology at the University-Eye Clinic of Heidelberg, said that the EDOF lenses have delivered promising results in initial clinical studies.

“Overall, the clinical results for EDOF IOLs show very good postoperative visual acuity for distance and intermediate vision as well as good near visual acuity. While near vision is slightly compromised with these IOLs, using an approach such as micro-monovision can enhance near visual performance,” he said.

Compared to earlier bifocal lenses, the EDOF lenses generate a high degree of patient satisfaction, noted Dr Auffarth.

“This is due to the fact that they do not lose so much contrast sensitivity because almost 85-to-90% of the light energy is directed on one focal area and there is a very low incidence of optical phenomena such as halos and glare. What we have also seen, especially with the IC-8 IOL (AcuFocus), is that it is very forgiving lens which delivers excellent outcomes even if we are more than 0.50D from the intended refractive target,” he said.

For Dr El-Massry, the EDOF lenses are out-performed by the trifocal IOLs in terms of the quality of near vision that they offer.

“The main objective for our patients is to see well at near and far. When we tell them that they may experience some compromise for near vision if they select an EDOF lens it makes them think twice. In our experience, with EDOF lenses about 5% of patients will still need reading glasses,” he said.

Dr El-Massry said that a trifocal lens such as the FineVision (PhysIOL) diffractive IOL offers excellent visual acuity at all distance points. The lens combines two diffractive structures, one with a 3.50D addition for near vision and one with a 1.75D addition for intermediate vision.

“We are assessing the lens in an ongoing prospective study with 74 eyes of 37 patients implanted so far. All of the patients are spectacle-independent at 16 months with excellent, near, intermediate and far visual acuity. None of them complained of any difficulty with night driving, reading or intermediate tasks,” he said.