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Cover Story
T HE P R E SB Y OP I A OP P OR T UNI T Y
each subsequent IOL model taking a
giant step forward from the previous
generation. The challenges with
the former models have always been
intermediate vision and dysphotopsia:
glare and halos, especially at night. 3. Keratophakia or corneal inlays:
The latest trifocal diffractive IOL These are permanent-yet-reversible
(PanOptix® from Alcon) improves implants that are surgically inserted
intermediate vision by providing a into the corneal stromal tissue of the
third focus, while the extended depth non-dominant eye to help manage
of focus or EDOF IOL (TECNIS presbyopia by increasing the eye’s
depth of focus at near. They may be
Symphony® from Johnson & Johnson
“ In the coming Vision, low-add Vivity® from Alcon) combined with LASIK in eyes that
have refractive error. Compared
creates an elongated focal point to
to monovision correction, there is
decade, if PC IOL increase the range of near vision, usually a five-to-six-line gain in near
with both showing less visual
technology disturbance than their predecessors. vision with one or no lines lost in
continues as it is The innovations are continuing with: distance vision with inlays, versus
only a one-line gain in near vision
now and there • the next generation refractive for every line lost in distance vision
3
is an adjustable monofocal IOL with higher-order with monovision . Side effects
include decreased contrast sensitivity,
EDOF lens in the aspheric design, that improves decreased night vision, compromised
intermediate vision (TECNIS
marketplace, Eyhance®) and the EDOF-multifocal distance vision, and the long-term
refractive lens hybrid (TECNIS Synergy®), both risk for interface haze development
between the cornea and the hydrogel
exchange or clear from Johnson & Jonhson Vision material.
lens extraction • the monofocal IOL with 1-D Several corneal inlays were introduced
may become the of EDOF for those who are not to the marketplace but the adoption
candidates for diffractive trifocal
“ • the Light Adjustable Intraocular was dampened by the FDA recall of the
norm for defeating IOLs (RayOne EMV® from Rayner rate by both surgeons and patients has
been slow and not widespread. Any
Father Time Global) momentum that inlays experienced
lens (LAL™) from RXSight® that
in 2019. The negative ripple effect left
offers near vision correction using Raindrop® inlay from ReVision Optics
EDOF technology and allows only one corneal inlay currently on the
post-operative IOL spherical/ market - the small aperture KAMRA®
cylindrical power adjustments to inlay by AcuFocus. With emerging
suit the person’s visual needs. treatment options such as pupillary
miotics (below) becoming more
In the coming decade, if PC IOL available, the future of corneal inlays
technology continues as it is now and looks poor, unless newer materials
there is an adjustable EDOF lens in the with enhanced biocompatibility are
marketplace, refractive lens exchange developed. At the time of writing,
(RLE) or clear lens extraction may clinical trials are underway for the
become the norm for defeating Father refractive Presbia Flexivue Microlens™
Time, akin to Botox injections and from PresbiBio that is similar to
dermal fillers for reducing/eliminating multifocal contact lenses and IOL, LLC
wrinkles and fine lines. and allogenic inlays.
10 / MAY - JUNE 2022 / www.ENVISIONMAGAZINE.ca /