Picking a Premium IOL
Understand your patient’s visual demands, and set realistic expectations.
This issue, we’re taking a break from our regularly scheduled contact lens programming to chat about IOLs. While IOLs are not contact lenses, these nonbiologic lenses can have a profound positive effect on patients and, thus, are worth including in the conversation. Next issue, we return to the contact lens front!
Premium IOL options provide a wide range of vision, making them an attractive option for our cataract patients. As we often identify cataracts and refer patients for cataract surgery, having a solid understanding of the types of premium IOLs, ideal candidates, and associated patient education are imperative to successful postoperative outcomes. Regarding the latter, it’s important to have targeted discussions with patients about their daily visual and lifestyle demands so we can recommend specific premium IOLs. Additionally, it is equally important to set realistic expectations regarding the premium IOLs themselves to lessen the potential for post-surgery disappointment. For example, regardless of the premium IOL, I recommend telling patients at the outset, “No IOL will provide vision equivalent to that provided by the natural human lens.”
With all this in mind, this issue’s column covers the types of premium IOLs, ideal candidates, and the related patient education needed to manage patient expectations (see Addressing Ocular Surface Health).
ADDRESSING OCULAR SURFACE HEALTH
While ocular surface health is not a criterion for picking a specific premium IOL, it is vital to the success of them all. This is because dry eye disease and Demodex blepharitis can significantly affect preoperative biometry measurements and postoperative visual quality. As a result, we must pay meticulous attention to the health of the ocular surface and treat any signs of dry eye disease and/or Demodex before biometry measurements are taken. Addressing the ocular surface is not an optional step; it is a foundational element for premium IOL cataract surgery.
MULTIFOCALS
These IOLs are designed to provide functional vision at multiple distances by splitting light into distinct focal points through a concentric design. There are various designs that have nuanced differences regarding contrast, clarity, and light transmission. These designs are the PanOptix (Alcon), PanOptix Pro (Alcon), Odyssey (Johnson & Johnson), Envy (Bausch + Lomb), and FineVision HP (BVI Medical).
Ideal Candidates
Those who want a large range of vision to lessen their need for spectacle correction. Other requirements include no ocular pathology and minimal nighttime driving.
Patient Education
“This IOL’s design can cause halos at night.”
FORWARD-THINKING OUTLOOK
Premium IOLs are quietly shifting eye care from a procedure-centered model to a patient-experience model. As more patients expect spectacle independence and customized outcomes after cataract surgery, the OD’s role in helping guide them to the best visual solution will become even more critical. Gain familiarity with premium IOLs, become the “vision goals” expert, and own the ocular surface before it’s a problem.
EXTENDED DEPTH-OF-FOCUS
These IOLs offer consistent distance and intermediate vision. The designs in this category are the Tecnis Symfony (Johnson & Johnson), IC-8 Apthera IOL (Bausch + Lomb), and AcrySof IQ Vivity Extended Vision IOL (Alcon). The IC-8 offers pinhole optics designed for irregular corneas.
Ideal Candidates
Those who value nighttime driving.
Patient Education
“You may still need readers for fine print or near vision tasks.”
LIGHT-ADJUSTABLE
The Light-Adjustable Lens (RxSight) is a monofocal silicone IOL embedded with photomacromers. These photomacromers allow for postoperative refractive adjustments via targeted UV light. Specifically, the IOL can be adjusted three times. When adjusted, the photomacromers create a concentration gradient, causing the lens to swell, inducing a power change.
Ideal Candidates
Those who have undergone refractive surgery or those who have high refractive demands and, thus, prioritize maximum precision.
Patient Education
“Postoperative care requires strict adherence to wearing UV-protective eye wear until the final refraction has been completed.”
TORIC
Astigmatism has significant effects on visual quality, giving us the unique opportunity to discuss with patients the ability for it to be corrected during cataract surgery with a toric IOL. Modern premium toric IOLs include the Clareon Vivity Toric (Alcon), PanOptix Toric (Alcon), Synergy Toric (Tecnis), Symfony Toric (Tecnis), Odyssey Toric (Tecnis), and Envy Toric (Envista).
Ideal Candidates
Those with corneal astigmatism equal to or greater than 1.00 D.
Patient Education
“Uncorrected astigmatism can affect your vision at any distance. A toric IOL can help correct it, but there might be times you still need vision correction at distance or near.”
SUCCESS LIES IN PROACTIVITY
Achieving patient satisfaction with premium IOLs relies heavily on understanding their visual demands and providing related education to best manage their expectations. Because of our longstanding relationships with our patients, we often know their personalities, how they use their eyes, their visual priorities and goals, and what has and has not worked with vision correction in the past. Let’s use these relationships to set these patients up for positive postoperative outcomes.
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