Page 12 - Envision-05-2022
P. 12

Cover Story


                                          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
                 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   /  /
   7   8   9   10   11   12   13   14   15   16   17