All Eyes on the IOL

Experts at APACRS 2023 give us the lowdown on the latest in presbyopia correction with IOLs

by Tan Sher Lynn

changes and the fact that hyperopes get more and more hyperopic over time.

Nevertheless, he doesn’t recommend performing LASIK for hyperopia even though it’s safe and easy — because LASIK has a limited correction range (<+3D), cannot treat presbyopia (except for aspheric ablation profiles), causes dry eyes after surgery, and doesn’t change the need for cataract surgery later in life.

At his eye clinic, EuroEyes, performing refractive lens exchange (RLE) with trifocal IOLs is the standard of care for hyperopic patients. The clinic recorded 95% patient satisfaction after primary refractive RLE surgery.

“I believe that performing RLE with trifocal IOLs is the best option in hyperopes above 30 years. It fully corrects all refractive errors including presbyopia, is permanent, and results in a stable solution. It does not cause retinal complications or dry eyes. It is a well-established and standardized surgery, and it can prevent cataract surgery later in life,” he commented.

Small aperture IOL

Ophthalmologists from Europe and the Asia-Pacific offered their views on selecting the suitable IOL and solution for presbyopia and hyperopia correction during a session entitled “The New Black in Presbyopia Correction” on Day 2 of the 35th Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2023) annual meeting.

Dr. Florian Kretz (Germany) explained the different IOL technologies available today, saying that for the overall vision, a combination of extended depth of vision (EDoF) and trifocal lenses (mix and match) is always a good choice.

For less dysphotopsia, monofocal plus with EDof IOLs (blended) will lead to better full-range vision. If one prefers distance-focused vision, EDoF IOL can provide emmetropic vision with hardly any dysphotopsia and spectacle independence to around 55 cm. Meanwhile, multifocal intraocular lens (MIOL) provides good visual acuity for distance and near vision, and true binocular near vision.

Hence, he stressed that the key questions to ask when choosing an IOL are whether the patient is suitable for diffractive optics (able to accept halos), how much defocus the cornea already creates, and which other optical principles suit the patient’s eye best.

“We have lots of technology available now so we can start to match the technology to the individual patient and not have one solution that should be fitting everyone,” he noted.

LASIK vs. refractive lens exchange for hyperopia

According to Dr. Michael Knorz (Germany), the lens in our eyes changes with age, leading to refractive

Meanwhile, Dr. Robert Ang (Philippines) offered tips and pearls for small aperture IOL surgery.

Drawing from his experience of using the IC-8 lens, Dr. Ang noted that patients with complex aberrated cornea may be a good population to start with for surgeons with less experience in small aperture IOL surgery.

“When you gain more experience, you will build confidence in using the IC-8 as a premium mono vision/low toric option in normal corneas,” he shared.

He noted that pre-op planning and managing patient expectations are important. “Don’t overpromise. With its extended range of focus, far vision is likely assured with strong potential for intermediate vision, while near performance is similar to EDoF and not trifocal lenses. It is also important to counsel the patient about the need for illumination and the possibility of glare and halos,” he concluded.