New IOL offers full-distance, good intermediate distance

Reviewed by Bret L. Fisher, MD

Presbyopia patients have changed. They are younger than ever, more active than ever before, and they have more treatment options than ever before. 

“There is an intense amount of interest in helping our patients who have cataract surgery to lessen their dependence on glasses postoperatively,” said Bret L. Fisher, MD, medical director, Eye Center of North Florida, Panama City. “As practicing ophthalmologists, we have been looking for lenses that offer solutions for our patients without too much compromise and that allow them a full range of vision without causing other problems.” 

Dr.  Fisher helped introduce the AcrySof IQ ReStor +2.5 D intraocular lens (IOL), the first in a new family of ActiveFocus IOLs from Alcon Laboratories, during the 2017 American Society of Cataract and Refractive Surgery annual meeting. This new lens design offers patients full-distance vision plus intermediate vision as close as 21 inches.

“This is the first multifocal lens implant that is truly distance dominant with 100% distance vision in its center portion,” Dr. Fisher explained. “We learned very early on that good distance vision is important. Patients don’t want to give up their very good distance vision to get intermediate and near vision. Most patients who have this lens in both eyes can comfortably read their iPad, their computer screen, and, what is also important for many people, their car dashboard.”

Meeting expectations

Surgeons recognize that meeting patient expectations is vital. A 2015 and 2016 survey by Brand Health Tracker found that surgeons ranked high patient satisfaction as the most important attribute of a presbyopia-correcting IOL.

The next most important attributes were delivering patient expectations and optimized distance vision. Optimized near and intermediate vision were down the list at numbers 10 and 13, respectively.

The ActiveFocus design has a 0.938 mm central portion optimized for distance vision. The central portion is surrounded by an apodized, diffractive multifocal zone with a second distance zone at the periphery.

This large peripheral zone allocates more light to distance as the pupil size increases. With a 3 mm pupil diameter, the new design allocates 69.4% of available light to distance vision and 18% to near vision, for a total light distribution of 87.4%.

The lens has seven diffractive steps across a diffractive region 3.4 mm in diameter and an area of 8.4 mm². Negative asphericity is -0.2 µm.

Active lifestyle

Active lifestyle

ActiveFocus can be a good choice for patients who have a more active lifestyle. That could include individuals who participate in sports, attend events or anyone who wants to see car dashboards or use a computer.

The same system might be helpful for patients who want more than monofocal vision or prefer an alternative to monovision. It could be even more helpful for those who want less dependence on glasses after surgery.

“For close reading or small-print reading, some patients may require mild over-the-counter reading glasses on a part-time basis,” Dr. Fisher noted. “There is always a need to have good lighting for these types of lenses. Most of us will lose a bit of sensitivity in the retina as we age, so good lighting can help there as well.”

Night vision disturbance has been one of the most important concerns with all presbyopia-correcting IOLs, he continued. Haloes around point sources, such as headlights, taillights, and street lights are a recognized problem and an objection that every surgeon must answer.

“With ActiveFocus, we are seeing the least amount of night vision disturbance that we have seen with any of the lenses that offer an expanded range of vision,” Dr. Fisher said. “There are definitely some flares, but most patients describe them as mild and they tend to improve with time as patients adapt to their lenses. We are getting much closer to a compromise free solution for our patients.”

Familiar lens platform

Familiar lens platform

One of the important features for surgeons is the familiar Alcon platform. The ActiveFocus family of IOLs uses the same biomaterial used in other AcrySof lens. ActiveFocus lenses are implanted using the same technique as other Alcon lenses.

As with other IOLs, surgeons must be attentive to managing astigmatism to achieve optimum results.

“All types of presbyopia-correcting lenses require meticulous surgery,” Dr. Fisher cautioned “but this one is very user friendly.”

One of the advantages is the relative flexibility in patient selection. The ActiveFocus platform can be used in patients with low, medium and high astigmatism, which makes it more inclusive than earlier generations of presbyopia-correcting lenses.

“This lens seems to have a larger sweet spot in terms of the type of patients we can implant,” Dr. Fisher said. “This lens is a bit more tolerant of dry eye, maybe a bit of aging-related changes to the retina, a little bit of mild glaucoma, even a bit of leftover astigmatism that the older generations of multifocal lenses. We can offer it to more people than we could before and, with good patient selection, be very confident we are going to make them happy.”

Bret L. Fisher, MD

P: 850-784-3937

E: bfisher@eyecarenow.com