ATARACT Surgical Tools
A Wide-Angle Glimpse of the Late A by Joanna Lee
t the 34th Asia-Pacific Academy of Ophthalmology (APAO 2019) Congress, attendees were treated to a wide-angle view of the latest tools and technologies available for better cataract surgeries – from newest developments in intraocular lenses (IOLs), to an insightful debate on the tools currently in the market for capsulotomy. These newly released technologies hold much promise for surgical efficiency and the potential for patients’ comfort and spectacle independence. However, as with every unchartered territory, there remains a need to test the efficacy and reliability of these technologies through trials in order to harness their full potential, especially for patient-specific conditions.
New Lenses on the Block A session, titled “New Technologies for Cataract Surgery”, began with Dr. Tim Schultz from the Department of Ophthalmology, University Eye Hospital Bochum, Germany, presenting a broad overview on IOLs. He reported about the latest clinical trials on enhanced depth of focus (EDOF) IOLs/presbyopia correcting IOLs which are “positioned somewhere between monofocal and multifocal IOLs”. So far, the few studies and cases reported have demonstrated good results for intermediate and near visual acuity with the lenses having advanced diffractive technologies, covering small aperture lens1 technologies, as well as the manipulation of lens aberrations and asphericity. While various EDOF lenses like Lentis Comfort and Lentis Mplus (Oculentis GmbH, Berlin, Germany), Instant Focus (SAV-IOL, Neuchâtel, Switzerland), Precizon (Ophtec B.V., Groningen, The Netherlands), Mini Well Ready (SIFI Medtech, Catania, Italy) and others have been
introduced in the market, Dr. Schultz highlighted the lack of randomized comparative studies in understanding the effectiveness of EDOFs. Out of 11 articles found on Pubmed, only one randomized controlled trial, a French study2, was found. Dr. Schultz’s team’s prospective randomized trial showed the TECNIS Symfony (Johnson & Johnson, Santa Ana, California, USA) and the IC-8 (AcuFocus, Irvine, California, USA) presenting good refractive outcomes for intermediate and near visual acuity with better distance visual acuity for the IC-8 group, especially under mesopic light conditions. Symfony was shown to perform slightly better for near visual acuity, but the issue of halos was reported.
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What about the other lenses on the spectrum? Dr. Gerd Auffarth emphasized on the newer generation of lenses, which promise to reduce the ‘glistening’ effect in patients. The latest enhanced monofocal IOLs, like the TECNIS Eyhance (Johnson & Johnson, Santa Ana, California, USA), are developed from optical technology “based on a continuous asphericity of a higher order”, meaning a continuous power change from the periphery to the middle of the lens. Dr. Auffarth was also involved in one of the trials two years ago. “It’s not an EDOF lens, but it allows for better targeting for on-spot refraction, giving a little bit more refractive tolerability and slight improvements in intermediate vision,” he shared.
