New Lens Technology for Cataract Patients
When a patient has cataract surgery, the surgeon is able to not only remove a patient’s cataract (the cloudy natural lens), but replace it with a new advanced technology lens that can correct vision and restore the focusing power of the eye. Previously, old generation artificial lenses used in cataract surgery were only able to correct for distance vision when implanted at the time of cataract surgery. However, over the last 20 years there have been numerous advances in artificial lens technology. Basic implants that only correct for distance vision are referred to as “Monofocal” Intraocular lenses (IOL’s). These can correct for basic nearsightedness or farsightedness at the time of cataract surgery. Newer monofocal IOL’s are now able to also correct for astigmatism (irregular curvature of the cornea).
However, there is still a profound loss of focusing power when a distance corrected monofocal IOL is implanted, and patients may have significant difficulty seeing their dashboard, cell phone, computer, and especially reading without glasses. Fortunately, there is another category of advanced technology lenses that also correct for presbyopia (loss of focusing power for near vision). These are called Multifocal and Extended Depth of Focus (EDOF) lenses.
Multifocal and EDOF lenses are able to use special optical features to allow vision across multiple focal points- not only at distance, but also intermediate (computer/cell phone range) or reading (newspaper/books). Recent advances include a new Trifocal IOL (Panoptix, Alcon) and a new EDOF lens (Vivity, Alcon). These two new lenses allow surgeons to customize visual outcomes for patients at the time of cataract surgery. Let’s examine the way these lenses work.
The Panoptix lens is a true trifocal IOL providing a full range of vision through distance, intermediate, and near. In the pivotal Alcon FDA study for approval of Panoptix, 99.2 % of patients when asked whether or not they were satisfied with their vision after surgery with the trifocal IOL reported high levels of satisfaction. In a multicenter study we participated in here in my practice, we found 83% of our patients reported never needing glasses when implanted with the Panoptix lens, and very high levels of satisfaction. However, the Panoptix lens is only designed for eyes that are relatively normal and have no other disease and very normal parameters.
The other issue with any multifocal lens like the Panoptix is that the optical design which allows for 3 focal zones (distance/intermediate/near) depends on light-splitting technology that can produce some haloes around point sources of light, like oncoming headlights. These haloes or “rings” around lights are typically not bothersome, and lessen over time. However, in some very rare cases, these may be bothersome. Patients who drive, fly, or boat frequently at night should be aware of this feature and consider this when deciding on their lens choice.
The EDOF lens option (Vivity) has a different and unique profile and design. EDOF lenses were designed to allow some extra focusing power compared to traditional monofocal lenses while not splitting light in the same way as a multifocal IOL. These lenses typically allow full focusing through two zones of vision, distance and intermediate. Patients will be able to maintain sharp distance vision and good vision for computer range and other intermediate tasks. Glasses may be required for low light and fine print, but with good light many patients have some degree of near vision with the Vivity lens. This type of design should theoretically also reduce the amount of halo or nighttime light phenomena when compared to a multifocal IOL. In a study comparing the Vivity lens to a traditional monofocal IOL, patients reported a similar and very low incidence of haloes, glare and starburst between the two groups. Because of the unique design features of the Vivity lens, it may also be a more forgiving lens, and be able to be implanted in a broader range of patients than the Panoptix lens.
These new technology lenses allow surgeons to customize vision correction at the time of cataract surgery to significantly reduce the need for glasses for most patients. If you or a loved one have cataracts, be sure to ask your surgeon if you are a candidate for one of these exciting new IOL’s.
1. Hovanesian J, Jones M, Allen Q. The PanOptix Trifocal IOL: A Study of Patient Satisfaction,
Visual Disturbances, and Uncorrected Visual Performance. Clinical Ophthalmology, In press
(Presented at American Society of Cataract and Refractive Surgery 2020)
2. Acrysof IQ Vivity Alcon data on file TDOC-0055576