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IOL evolution

Ten-year review shows steady improvement for multifocal IOL outcomes

Dermot McGrath

Posted: Saturday, February 1, 2020

Advances in multifocal IOL design and technology mean that surgeons now have the possibility to deliver a truly customised approach for their patients with excellent clinical outcomes and very few of the drawbacks associated with early-generation lenses, according to Michael Assouline MD, PhD.

“We did a long-term study of a number of different multifocal IOLs that we have used over the years in our clinic and have seen how the ongoing innovations in IOL design are reflected in improved clinical outcomes for our patients,” he told delegates at the annual meeting of the French Implant and Refractive Surgery Association (SAFIR) in Paris, France.

Dr Assouline’s retrospective study of more than 2,000 MIOLs focused particularly on the ability of more recent lenses to enhance the quality of intermediate vision for patients.

“We really wanted to establish the correlation between the different energy distribution of different MIOLs and the clinical results obtained. The functional outcomes show that the more advanced designs clearly result in better intermediate vision, which is very useful in everyday life, compared to the older bifocal models,” he said.

The study included consecutive cases of seven different lenses: AT LISA (Zeiss) in 193 patients; Lentis Mplus X (Oculentis/Topcon) in 751 patients, Lentis Comfort in 172 patients, FineVision (PhysIOL) in 234 patients; Bi-Flex 677MY (Medicontur) in 577 patients; PanOptix (Alcon) in 117 patients; and a selection of other IOLs in 55 patients. Outcome variables included best-corrected and uncorrected visual acuity for near, intermediate and distance, monocular and binocular defocus curves, subjective eye preference in mix-and-match cases for all distances and Nd: YAG capsulotomy survival curves.

Dr Assouline said that the lens choice he offers his patients has evolved over time to in step with advances in IOL technology and design.

“From 2008 to 2010 we started with the ReSTOR and Tecnis lenses with apodisation and bifocality, then made the transition to AT LISA. Then came trifocality with the FineVision IOL, which was a very successful lens in France from around 2015 to 2017. I then moved to mix-and-match with the combination of Lentis Mplus in the dominant eye and the Bi-Flex 677MY in the other eye. The majority of my current multifocal cases are Bi-Flex 677MY, which is the most balanced polyvalent lens on the market, and I am also trying newer lenses such as PanOptix and PresbySmart (Innophta) to see what additional benefits that might bring,” he said.

Summing up the overall outcomes of the study, Dr Assouline said he believed that the most useful recent innovation was the restriction of the diffractive structure to the central portion of the optic of MIOL (3mm for the Medicontur and 4.5mm for the PanOptix), which leaves a purely refractive surface in the periphery to improve distance vision with a large pupil (night vision) and reduce untoward phototic phenomenons.

In addition, he mentioned that he has discontinued the Lentis IOL after cases of calcification (requiring explantation of two lenses from a total 901 cases), until a satisfactory feedback and long-term follow-up of the corrective action can be provided by the company.

“You need to have confidence in the material you are using. The Medicontur Bi-Flex “LIBERTY” lens is made of a proven material that comes with a very low chromatic aberration index. It has an original and very convincing design with the optical bench simulation, which is matched by excellent outcome in the clinic,” he concluded.

Michael Assouline: dr.assouline@gmail.com