IOL technology must be matched to patients' needs

Dorado, Puerto Rico-Physicians delving into the refractive cataract surgery arena should be careful screening and selecting patients to ensure the best results. In order to do this, surgeons need to survey patients about their needs and desires pertaining to their vision, so that the appropriate IOL technology can be chosen, explained Louis D. "Skip" Nichamin, MD, who spoke during the Current Concepts in Ophthalmology meeting here.

The crystalens (eyeonics), ReZoom IOL (AMO), and the AcrySof ReSTOR IOL (Alcon Laboratories) are the three lenses that all perform quite well, although there are subtle differences, he noted.

"This is where the crystalens really shines, basically, 100% across the board at 1 and 3 years," he said. "These lenses get better over time."

Cell phone, personal computer (PC), and personal digital assistant (PDA) use has grown exponentially over the last 5 years. From 2000 to 2005, worldwide mobile phone shipments have grown from 413 million to 740 million. During that same period, portable PCs have taken off from 134 million shipments in 2000 to 182 million shipments in 2005, and PDA use has also increased from 11 million in 2000 to 39 million shipments last year, Dr. Nichamin said.

"The limitation of the crystalens is that it is a little weaker at near uncorrected vision," Dr. Nichamin said. "It is somewhat unpredictable. The FDA trials indicated 1 D of accommodation. I would say that one achieves about 1 to 1.5 D of accommodation compared with a monofocal lens. Basically, enhanced pseudoaccommodation is taking place."

Another potential drawback with this IOL is capsular contraction syndrome, also known as Z syndrome, which may occur because of the hinged haptics. In his experience of implanting several hundred crystalens IOLs, Dr. Nichamin said he has never had this problem. The key to avoiding the problem is good cortical cleanup. However, if it does occur, the surgeon can perform a YAG laser capsulotomy, he said.