Presbyopia treatment

Patients the winners in relentless race for progress

Dermot McGrath

Posted: Tuesday, October 1, 2019

Advanced intraocular lens technology and surgical techniques have significantly improved postoperative visual outcomes in recent years, with surgeons now able to offer a wide array of potential solutions tailored to the specific refractive needs and lifestyles of their patients, according to Béatrice Cochener-Lamard MD, PhD.
“We are very lucky to be ophthalmologists at a time of major advances in optics and IOL technology,” she told delegates attending her keynote lecture ‘From premium to EDOF IOLs: Race for progress’ at the European Society of Ophthalmology (SOE) meeting in Nice, France.
“The progress in optics in recent years allows efficient compensation of accommodation loss. Trifocal lenses have emerged as the clear winners in Europe for presbyopia correction for multitasking patients, and the new extended depth-of-focus (EDOF) lenses also offer a compelling compromise that may extend the number of patients and surgeons interested in these solutions,” she said.
In a wide-ranging lecture focusing on recent developments in “premium” lens designs, Prof Cochener-Lamard said that today’s surgeons can choose from an ever-increasing array of “advanced” monofocal, multifocal and extended depth of focus IOL options to meet their patients’ needs.
She said that progress over the past decade has been particularly noteworthy in terms of presbyopia-correcting IOLs, with the emergence of concepts designed to compensate for the loss of accommodation, when we are still looking for a true accommodative IOL, that could restore accommodation.
“The race for progress has focused 
on two priority objectives: to offer spectacle independence by restoring effective vision at all distances while optimally respecting the quality of vision, particularly in terms of contrast vision and night driving,” she said.
The range of diffractive multifocal IOLs began with bifocals with variable additions, and all available in toric version, as a key refinement when we know that the achievement of emmetropia is required with multifocal IOLs. Then came trifocal lenses that added intermediate vision enhancement to both elementary distances at far and near, and come also in toric version.. The latter have proven the most popular in Europe, said Prof Cochener-Lamard.
More recently, the EDOF lenses have brought some new features into play, providing a range of visualisation rather than a single focal point and offering some degree of spectacle independence by improving near and intermediate vision with minimal impact on distance. Actually, “EDOF” design one goal for different concepts : extended focal zones, asphericity modulation, pinhole. She added that these lenses are also more “forgiving” for remaining refractive error than multifocal IOLs, minimising haloes and glare and reducing contrast sensitivity loss at distance.
“What all this technology equates to is that these IOLs are very well adapted for ‘social vision’, to enable people to accomplish tasks such as computer work, cooking, shopping, playing games, and outdoor activities. This is apparent when we study the binocular defocus curve in a dome-shaped EDOF lenses that they perform particularly well at these intermediate distances,” she said.
Compared to earlier multifocal lenses, the EDOF lenses generate a high degree of patient satisfaction, noted Prof Cochener-Lamard.
“We have carried out several comparative studies of these diffractive lenses at our clinic in Brest and the patient satisfaction was consistently high for all the IOLs that we studied. I think the fact that these IOLs deliver good quality of vision, maintaining contrast sensitivity and with a very low incidence of optical phenomena such as haloes and glare, accounts for the high percentage of satisfied patients,” she said.
The key to obtaining optimal outcomes with EDOF IOLs, and indeed other multifocal lenses, lies in careful patient selection, education and counselling, advised Prof Cochener-Lamard.
“It is vital to select patients who are motivated and have reasonable expectations, who understand the compromises involved and who aren’t looking for perfection. It is important to discuss with them issues such as neuro-adaptation, dependence of surrounding light conditions, degradation of night vision, and the risk of certain side-effects before the surgery,” she said.
Surgeons should avoid implanting these lenses in patients with ocular diseases such as glaucoma, maculopathy, corneal abnormalities, moderate amblyopia, strabismus, ocular surface disease or poor binocular vision.
With uptake of multifocal IOLs still representing only about 4-to-5% of the total global IOL market, Prof Cochener-Lamard said that a lot of work needs to be done to educate ophthalmologists and the wider medical community of the potential benefits of these lenses.
“There are a lot of factors holding back the market, often based on fears related to complications experienced with older models, but which are no longer an issue with today’s lenses,” she concluded.

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