Allergy

Blepharitis

COVID-19

Cataract

Comanagement

Comprehensive Eye Exams

Conjunctivitis

Contact Lenses

Cornea

Diabetic Eye Disease

Dry Eye

Geographic Atrophy

Glasses

Glaucoma

LASIK

Lens Technology

Lid and Lash

Myopia

Nutrition

Ocular Surface Disease

Optic Relief

Patient Care

Pediatrics

Presbyopia

Ptosis

Refractive Surgery

Retina

Technology

Therapeutic Cataract & Refractive

News

All News

Practice Management

Media

All Videos

Expert Interviews

Podcasts

Medical World News

Viewpoints

Insights

Case Based Roundtable Series

Case Studies

Case of the Quarter

Practice Ownership

Rapid Readout

What’s Your WhEYE?

Conferences

Conference Coverage

Conference Listing

Conference Recaps

Blog

Publications

Digital Edition

Supplements And Featured Publications

iTech

Partners

Resources

Job Board

Subscribe

Articles

The collaboration allows Topcon to become the exclusive global distributor of Inspire, RadiusXR’s new wearable vision testing platform.

Topcon Healthcare, RadiusXR, and Glaukos enter into a collaboration

A recent study assessed the effect of a modified TCLB procedure that added deframing and decompression maneuvers to the LOFC and its support structures to obtain better results for both the lower and upper lids.

Eye-opening effects caused by modified transconjunctival lower blepharoplasty

Dr. Mile Brujic practices in Bowling Green, OH. He also owns Optometric Insights, a service providing career coaching to optometrists. He has received honorarium for speaking, writing, participating in an advisory capacity or research from: Akorn, Alcon L

Videos

Mile Brujic, OD, FAAO; Nate Lighthizer, OD, FAAO; Brianna Rhue, OD, FAAO, FSLS; Ben Casella, OD; and Ben Gaddie, OD, FAAO shared their insights from the conference.

What optometrists gained from attending SECO 2025

The FDA has set a PDUFA target action date of October 23, 2025, for the low-dose atropine formulation.

FDA accepts NDA for low-dose atropine from Sydnexis

The leading source of breaking news, news analysis, and emerging research reports in optometry, Optometry Times® disseminates practical content by optometrists for optometrists that can be immediately applied to improve the clinical experience.

Advertise

About Us

Editorial

Contact Us

Terms & Conditions

Privacy

Do not sell my Information

Optometry Times | Clinical News & Expert Optometrist Insights

Facebook

Instagram

LinkedIn

Spotlight

Clinical

Myopia- Management

1rem

Authors

8 tips to add sports and performance vision to your practice

At Vision Expo East 2025, a group of panelists presented new data released by the Contact Lens Institute (CLI) on purchase factors driving contact lens searches online.

In the first installment of a 2-part Q&A, Charissa Lee, OD, MBA, FAAO; Ryan Corte, OD; Roxanne Achong-Coan OD, FAAO, FIAOMC, FSLS, Dip CCLRT; and Nishan Pressley, OD share their insights in an exclusive interview with 

What are the key identifiers in finding the best candidate, whether it’s dual wear or contact lens wear.

I would say the number 1 characteristic would be motivation, right? If I'm telling you that this is an option and you're getting excited about it, okay, great. I got you. Let's do it. But that apprehensive, super anxious patient, "I can't even put drops in my eyes. I'm thinking about it, but I can't put drops in my eyes." That's going to be a longer conversation, of course, but ultimately, really just that motivation to want to wear contacts and see if it works for them. I think that's the number 1 characteristic I look for, that excitement behind trying something new.

Roxanne Achong-Coan OD, FAAO, FIAOMC, FSLS, Dip CCLRT:

“Yeah, and even if they're excited and afraid, so, for example, patients with a high prescription. They're thinking, "Oh, man, are these going to feel thick on my eyes too?" The reality is, they come in and they say, "Wow, I put these on and everything looks bigger, right?" This is like the real size world. And also they don't have the peripheral vision, just to cost me some supplementals, they're excited about too. So I think patients like those will be ideal candidates for contact lenses.

I do believe, too, that the industry has done a nice job advancing the technological innovations that have taken place with contact lenses. So, I had a patient when I asked her on a scale of 1 to 10 how interested are you? And she was, like, 30 or 40, if I remember correctly– mid 30s – dropped out of contacts years ago because they just weren't meeting what she needed. They weren't comfortable. A lot has changed in that time frame. And, she was anew patient to me. So I said, "Have you tried X, Y, or Z?" And we were able to get her back into contact lenses based off some of these technological innovations. And she was so grateful. So desire, but also education, that you are a candidate. I'm looking at your refraction. I'm looking at your eye health, and overall, you know, ocular surface, you could easily be a candidate for contact lenses. Let me reintroduce to you why, and educating them on what's come through the pipeline of technology.

So what I’m hearing is that just because they’ve said no before doesn’t mean that they’ll say no when they’re in your care.

Yeah, you guys all have patient stories about how you change their lives just by bringing it up again because they thought they weren't a candidate before, and now their life has changed because you've offered it again.

It's so gratifying, too. I mean, that's half the reason I even became an optometrist is the instant gratification of vision. Just knowing that we can do that, sometimes we take that for granted as even an optometrist. But you never know who's sit in your chair and what their journey is to get there.

Are there any final thoughts you want to share?

I really love that the data being pulled gives us more perspective on what are patients' and/or you could say consumers' really thinking outside of the exam lane. We're all humans, so we all Google things, we all try to find out more information on whether it's the overall visual quality, overall eye health quality. But also we're cost conscious at times, and so we have to have a value driven conversation to our patients, to share the value of not only our services, but the products that support those services.

Yeah, and I have to say this research has opened my eyes to a lot of things, and that has taught me about different things. For example, removing lenses, right? I thought, "Wow. I would never have thought that would have been on the report," but I'm thinking of ways I can change it in my practice too. So these are really good ideas that we think about, and then we can pass on to other doctors. So I love that you guys are doing all this great research.

These are fun tidbits that in a practice setting, you wouldn't normally have that access to that information. So the work, the research that that the CLI is doing is really just to open our eyes to how to take better care of our patients and just some of the stuff that you guys were all talking about, just little tweaks in our day to day in our office, can make a big, big difference.

Purchase factors drive online contact lens searches, according to new US and Canadian research. News release. Contact Lens Institute. February 18, 2025. Accessed February 27, 2025. https://www.contactlensinstitute.org/news/digital-search25/ 

Charissa Lee, OD, MBA, FAAO; Ryan Corte, OD; Roxanne Achong-Coan OD, FAAO, FIAOMC, FSLS, Dip CCLRT; and Nishan Pressley, OD; give their insights on distinguishing the best candidates for contact lens wear.

Vision Expo East 2025: An exclusive Q&A on finding the right fit for dual, contact lens wear – Part 2

In the first installment of a 2-part Q&A, Charissa lee, OD, MBA, FAAO; Ryan Corte, OD; Roxanne Achong-Coan OD, FAAO, FIAOMC, FSLS, Dip CCLRT; and Nishan Pressley, OD share their insights in an exclusive interview with 

What are some key takeaways or surprising findings from the research?

I would say my key takeaway from the trends is that as us practitioners, we just need to make sure that we do our due diligence when it comes to educating our patients. Some of the data that really surprised me was honestly patients googling how to take out their contact lenses. We know that they do the training. I make sure you can do it before you leave the office. But that was one of the top searches, 2 times more, than how to actually insert your contact lenses, so the fact that patients are still struggling possibly with the removal of the contact lenses, doing our due diligence when it comes to educating and doing follow up questions like, "Are you comfortable? Do you need more help?" And just being that advocate that our patient needs, and let them know that we'll always be there for them, even if they're having a difficult time.

What is the best way to transition internet search inquiries into the office?

So we talked earlier about raising awareness that we actually sell contact lenses in our office. So a lot of time we assume that patients will buy from us, but we don't have anything displayed physically out in the optical that after you get your eye exam, you can get your contact lenses from us. So I think talking about it in the room, seeing how we can match prices, compare prices, and we have systems where it'll actually compare online versus a retail and compared to our practice. And we talk about having better rebates and online presence too. So just bringing it up in the room, making them aware of it also.

What are some of the best practices into segwaying into discussion about contact lens wear?

Yeah, we talked a lot about this on stage, but also just as a group. And the reality is, you can't make assumptions about the patient's eye health and vision care journey. So whether they call in and say out just here for a routine eye exam, or they mark on their digital intake or in-person intake form that they're just there for routine eye care, opening up that conversation of, "How do you utilize your eyes throughout the day? What are some of your your hobbies?" And also asking them general questions like, "Why are we doing contact lenses today?" or "On a scale of 1 to 10, how interested are you in contact lenses?" So it opens up a very simple conversation that we can quickly go 1 of 2 ways. So if they are just shutting it all down and they have no interest, we find that out very quickly, but a lot of times there is varying degrees and levels of interest, and you just don't know what the patient's been told or what they've told themselves during their prior appointments. And so opening that up is absolutely huge. We all agree that the "and" conversation, contact lenses and glasses, is what's best for the patient and best for the practice.

Yeah, and I'll just add that in the research that we did, over 90% of those queries were an "or" or "versus." And so what we can see from from the research, is that they don't necessarily understand that there's the "and," right? Because only 6% were an "and." So I love what Dr Corte says about bringing it up in the office to make sure that they understand, because they probably don't know that they can do both.

Going off of that, what do you think are some of the most common misconceptions that patients have about dual wear?

I would say for me, what I hear my patients say all the time is they think that if they start to wear contacts, that has to be their primary correction if you go when, in reality, I'm sitting here like, "No, that's why we have daily disposable lenses." There's options for you when it comes to contact lenses. You don't have to wear them every single day if you don't want to. But if there's a special event, if you know you enjoy pickleball, if you know you enjoy golfing, go to the time that you can wear your contacts, and it's going to be okay. So just having that conversation where this doesn't have to be an everyday thing. This is another way to redirect your vision that's going to help out with your everyday visual needs.

And even patients who have an astigmatism, they don't even realize that it comes in astigmatism prescription, and multifocals is a huge one. A lot of times they think, "Oh, when I wear contacts, I have to look through all these different zones or I have to tilt my head." I said, "That's the beauty of contact lenses. So you can look up here and still see up close. So you have those misconceptions like, "Well, I don't know if I want those, and it sounds so complicated, and it sounds expensive, so I don't want to get contact lenses."

Yeah, to act off all that, they don't know what they don't know. A lot of times they may not even feel they're eligible, or they don't have any coverage, or they're so busy, they came in for a primary endpoint of getting things updated, and it takes us or our team to introduce them to even putting that in their mind as an option.

Yeah, I think one of you guys brought up that reinforcing it with your staff and reminding your staff about the "and" conversation throughout that patient journey, even in our own offices, it's an opportunity too.

Charissa Lee, OD, MBA, FAAO; Ryan Corte, OD; Roxanne Achong-Coan OD, FAAO, FIAOMC, FSLS, Dip CCLRT; and Nishan Pressley, OD; give their insights on recent Contact Lens Institute research on contact lens purchase factors and Google searches.

Vision Expo East 2025: An exclusive Q&A with CLI panelists on recent research – Part 1

In today’s interconnected yet often isolating world, the importance of finding a supportive community, or "tribe,” cannot be overstated. Whether in our personal lives or professional careers, being part of a group that understands, supports, and uplifts us can make all the difference. This sense of belonging is particularly vital in demanding fields like optometry, where the challenges are unique, and the need for mutual support is paramount.

Belonging to a community means having a network of people who understand your journey. These connections provide emotional support and encouragement, helping members navigate challenges and celebrate successes together. This shared experience can reduce stress and enhance overall well-being.

A tribe provides a fertile ground for learning. Members can share insights, experiences, and advice, offering a collective pool of knowledge that benefits everyone. This exchange is crucial in constantly evolving professions, ensuring everyone stays updated and competent.

Being part of a community offers numerous opportunities for professional development. From attending workshops and seminars to engaging in mentorship and collaboration, the avenues for growth are abundant. This continuous learning and development are essential for staying relevant and excelling in any field.

A supportive tribe empowers its members to push beyond their limits. This empowerment stems from collective encouragement and the confidence that comes from knowing you have a network of allies. This shared strength enables individuals to tackle new challenges and achieve their goals.

Finding your tribe in professional settings

In the professional realm, finding a tribe can significantly impact career satisfaction and success. Organizations and associations that foster a sense of community provide a platform for networking, learning, and mutual support. These groups can be beneficial for women in specialized fields, offering a space where they can connect with peers who share similar experiences and aspirations.

Bringing it all together: The 2024 Educational Retreat

One such example of a community that brings these values to life is Optometry Divas. This group has cultivated a supportive network for women in optometry, emphasizing the importance of connection, growth, and empowerment. The upcoming 2024 Educational Retreat from August 2 to 4 in St Augustine, Florida, is a testament to these principles.

The retreat, whose theme is “Unleash Your Power,” is designed to help attendees break through personal and professional barriers. It offers 20 continuing education credits, but the true value lies in connecting with like-minded professionals, sharing experiences, and building lasting relationships. The retreat features transformative courses, a business boot camp, and inspiring sessions, all aimed at fostering a sense of community and empowerment.

Finding your tribe is more than just joining a group; it’s about building meaningful connections that support your growth and well-being. Whether through shared knowledge, emotional support, or professional development, the benefits of a strong community are undeniable.

As we look forward to events like the 2024 Educational Retreat, we are reminded of the power of coming together, supporting one another, and unleashing our full potential. In every facet of life, our tribes help us thrive, achieve, and inspire.

Networking and skill sharing are just some of the building blocks to developing a professional community.

The power of finding your tribe: A path to personal and professional growth

Dr. Nate Lighthizer shares key takeaways from the SECO Showcase on anterior segment technology and full laser certification course offered at SECO.

SECO 2025: Exploring the latest in anterior segment technology and laser treatments

SECO continues to be a leader in optometric education, providing practitioners with hands-on exposure to the latest advancements in anterior segment technology. This year’s SECO Anterior Segment Showcase, led by Nate Lighthizer, OD, FAAO, and Chris Wroten, OD, offered an engaging and interactive experience for attendees.

The session focused on cutting-edge technology that enhances anterior segment diagnosis and treatment. Companies like Nidek showcased their latest advancements in anterior segment lasers, including selective laser trabeculoplasty (SLT). Additionally, participants explored anterior segment imaging through optical coherence tomography (OCT) and innovative radio frequency devices designed for cosmetic and therapeutic applications.

One particularly exciting highlight of the event was the incorporation of wearable technology designed to enhance auditory assistance, demonstrating how optometrists can integrate multidisciplinary solutions into their practices. The discussion also covered the expanding role of intense pulsed light (IPL) therapy in managing ocular surface diseases and dry eye conditions.

After an initial introduction to the latest technological advancements, Lighthizer and Wroten facilitated a unique hands-on workshop. Attendees were divided into small groups and rotated through multiple stations, each offering a 10-minute interactive session with different devices. This format allowed practitioners to gain practical experience with new tools, including lasers, imaging systems, and radio frequency treatments, providing valuable insights on how these innovations could be implemented in clinical settings.

Workshops like the SECO Anterior Segment Showcase are crucial for keeping optometrists at the forefront of technological advancements. By offering real-world exposure to emerging devices and treatment modalities, SECO helps bridge the gap between theory and clinical application, ensuring that optometrists can deliver the highest level of patient care.

As technology continues to evolve, events like these reinforce the importance of continuous education and hands-on training. Optometrists who stay informed about the latest developments in anterior segment technology will be better positioned to provide advanced, patient-centered care in their practices.

Conference

-correcting IOLs has been evolving rapidly. Several new IOLs have entered the market in the past few years, and more are expected to become available in the future. Helping our patients navigate the decisions regarding these lenses often improves their satisfaction after 

. Patients look to us for advice on whether to consider a presbyopia-correcting IOL, what attributes to prioritize in their choice of lens, and whether their postoperative visual experiences are typical. Despite immense amounts of online information, this information is often hard to discover, obscured by marketing, and difficult to verify.

Our surgery center has kept up with the current explosion in multifocal IOLs, and we have learned many lessons by observation and by the assistance of patients who kindly share their experiences with us. This article will explain the advantages and disadvantages of the best of the current presbyopia-correcting IOLs, how the changing technology affects appropriate patient selection and counselling, and what to expect if your patient receives these lenses.

The laws of physics prohibit the creation of an ideal multifocal IOL; it is impossible to create a lens that can provide a perfect image at varying distances, with no aberrations and no loss of light. Therefore, the key to successful multifocal IOL selection is an intimate knowledge of the compromises inherent in each option. In addition, the more your patient can clearly state which strengths are the most desirable to them personally and which compromises are acceptable, the better their satisfaction will be with the final decision.

 Some of the more common strengths of the current multifocal IOLs are shown in 

, where prioritizing 1 wing of the triad will generally result in a compromise in the other 2 wings.

Multifocal IOLs are not a good option for everyone, whether due to patient temperament, the additional cost, the vagaries of neuroadaptation, the effect on daytime and nighttime vision, or simply an affection for glasses. Certain patients will never be pleased with multifocal IOLs and should not be pressured.

However, improved optical properties in newer multifocal IOLs mean that more and more patients can be considered for these lenses. Long regarded with suspicion due to significant optical aberrations, the newest crop of multifocal IOLs have finally achieved a remarkable level of performance and are a good choice for many patients.

There have also been recent advancements in monofocal IOL technology, with several next-generation monofocal IOLs entering the market, including the Tecnis Eyhance (Johnson & Johnson Vision) and the RayOne EMV (Rayner). Although one of the noticeable improvements over conventional monofocal IOLs has been a small increase in the depth of focus, those IOLs are still not powerful enough to be considered extended-depth-of-focus (EDOF) IOLs and thus are not reviewed in this article.

The PanOptix IOL (Alcon) is still the only trifocal IOL available in the United States, and many surgeons have adopted it enthusiastically as an improvement over older bifocal IOLs. One of this IOL’s most attractive features is the usefulness of its 3 focal points—emmetropia, 24 in (+1.67 D), and 16 in (+2.50 D)—corresponding comfortably to many common activities. The PanOptix IOL is available in spherical powers and with toric correction of between approximately 1.00 and 2.60 D. It achieves its effect with a sophisticated series of diffractive steps molded onto its anterior surface.

Diffractive optics reduce contrast sensitivity, the ability to discern objects with similar color and brightness, especially in low lighting. Because corneal or macular disease will also reduce contrast sensitivity, all diffractive IOLs are contraindicated in eyes with these diseases to avoid any additive effect.

 Even with its superior chromatic aberration control, the PanOptix IOL is still contraindicated in eyes with significant ocular surface disease, basement membrane dystrophy, epiretinal membranes, and diabetic retinopathy. 

Like all diffractive lenses, the PanOptix IOL produces glare, haloes, and starbursts, collectively known as dysphotopsias. The PanOptix technically has 4 focal points, 2 of which overlap to strengthen distance acuity. This strategy also works to reduce dysphotopsias to some extent.

The PanOptix IOL tends to provide good distance, intermediate, and near vision, with nighttime aberrations that are acceptable to most patients. For a patient who desires good vision across a wide range of distances, the PanOptix IOL is a great choice.

Like the PanOptix, the Tecnis Synergy IOL (Johnson & Johnson Vision) is a diffractive multifocal, though with a slightly different mechanism. The Synergy IOL has 1 focal point at plano and a broad range of near vision, from approximately 26 in (1.50 D) to 13 in (3.00 D). The Synergy IOL is available in spherical powers and as a toric version with astigmatism correction from 1.00 to 2.60 D.

 The design of the Synergy IOL borrows several successful elements from the TECNIS Symfony IOL, including an EDOF design (here used to cover the near range), minimization of chromatic aberration, and reduction of spherical aberration. The Synergy IOL has a syncopated concentric sawtooth pattern lathed onto its posterior surface, as well as a frosted edge to reduce dysphotopsias.

 Patients often notice slightly better very near vision with the Synergy IOL compared with the PanOptix IOL.

The more aggressive range should produce greater glare and haloes, but the Synergy uses a violet light filter on the posterior surface that blocks wavelengths from 360 to 460 nm, reducing these aberrations. On average, patients rate the glare and haloes as similar to those of the PanOptix IOL. The Synergy IOL is contraindicated for any case of corneal or macular disease due to the compounding effect of contrast sensitivity degradation.

The Synergy IOL is a great choice for patients who want good distance, intermediate, and near vision, and particularly those who have enjoyed and want to preserve very near vision and who do not mind some nighttime aberrations.

EDOF IOLs trade less satisfying near visual acuity in exchange for crisper distance vision and fewer aberrations. They tend to be a good choice for patients who are concerned about the risk of nighttime glare and haloes, those who are prevented from getting a diffractive multifocal IOL because of mild corneal or macular disease, and those who do not prioritize very near vision.

EDOF IOLs are defined by the FDA as lenses that provide Snellen visual acuity to within 1 letter of that provided by a monofocal IOL, and a depth of field that is at least 0.50 D greater than a monofocal.

 Depending on pupil size, most monofocals already provide 0.75 D to 1.00 D of depth of field, so an additional 0.50 D of depth of field increases that from 1.25 D to 1.50 D. This brings objects that are only 24 to 30 in away into focus, encompassing vehicle dashboards, computer monitors, and tablets.

EDOFs are well suited for patients who want some depth of field to increase their glasses independence but do not mind resorting to reading glasses for close work or work in dim light. They tend to perform very well for active individuals who spend a lot of time outdoors and want some near function but will not tolerate compromises to their distance vision.

Although Bausch + Lomb’s Crystalens (2003) and Johnson & Johnson’s Tecnis +2.75 (2015) both arguably fit into the EDOF category, neither is used much anymore; the pseudo-accommodative movement of the Crystalens rarely worked as hoped, and the older optics of the Tecnis have fallen out of favor.

 Therefore, we will primarily cover 2 newer EDOF IOLS: the Vivity and the Symfony.

In contrast to the diffractive multifocal IOLs, the Vivity IOL (Alcon) is a nondiffractive (or refractive) lens, using sophisticated optical elements on its anterior and posterior surfaces to elongate the range of focus significantly. The Vivity functions as an EDOF IOL, with continuous vision from infinity to approximately 26 in (+1.50 D).

 The Vivity is available as a spherical and a toric version, with toric powers compensating for 1.00 to 2.45 D of corneal cylinder.

Despite its weaker performance at near when compared with other MFIOLs, patients have been enthusiastic about the Vivity; one big reason for this is the near absence of glare and haloes. A great benefit of its nondiffractive design is having similar nighttime aberrations to those of a monofocal IOL. Patients commonly describe their vision through this lens as “natural.”

Because of the minimal aberrations, the Vivity IOL can sometimes be implanted in patients with mild corneal or macular disease, as long as they receive appropriate counselling. Thus, the Vivity has expanded our pool of potential candidates for presbyopia-correcting IOLs. According to one study, although the Vivity IOL can be implanted in eyes with mild epiretinal membranes, the macular pathology may negate much of the EDOF effect, effectively leaving the patient with an expensive monofocal.

The Vivity provides good distance and intermediate vision, but like other EDOFs, it does not typically allow for good uncorrected near vision. If acceptable to the patient, a minimonovision strategy can bolster near vision considerably. The Vivity IOL is a great lens for patients who want good distance and intermediate vision, do not mind wearing reading glasses for some near tasks, and would dislike any glare or haloes.

The TECNIS Symfony EDOF IOL (Johnson & Johnson) uses diffraction to split light between 2 close foci, resulting in a bifocal IOL with focal peaks at plano and at +1.75 D (22 in). These peaks merge such that in most lighting conditions, patients experience a continuous range of good vision all the way from infinity to intermediate distance. In dim lighting, a perceptive patient may notice 2 separate peaks.

 The Symfony IOL comes in a spherical and a toric version; the toric model can correct for corneal astigmatism of between 1.0 to 2.6 D.

The Symfony is a diffractive lens with a concentric sawtooth surface pattern on the anterior surface.

 This IOL may produce glare, haloes, and starbursts similar to those of the Synergy.

One of the more ingenious strategies employed by the Symfony is a reduction in chromatic aberration that is achieved by manipulation of the diffractive design. This results in superior contrast sensitivity compared with most other presbyopia-correcting IOLs.

 This same design strategy has been employed in the Synergy IOL. Even with its superior chromatic aberration control, the Symfony is still contraindicated in the presence of any corneal or macular disease.

The Symfony tends to provide good distance and intermediate vision but does not perform well at near vision. Some patients are amenable to a strategy of minimonovision, whereby the nondominant eye is targeted at –0.50 D; this slight adjustment can give more functional uncorrected near vision.

 With the success of the Synergy, which employs similar optics but achieves a more powerful range, many surgical centers have seen the use of the Symfony IOL decrease. In general, the Symfony is a good IOL for patients who desire good distance and intermediate vision and do not mind some compromise to their near vision and some nighttime aberrations.

A new type of EDOF IOL has been recently FDA approved in the United States—the IC 8 small-aperture IOL (AcuFocus, Inc)—although it is yet to be released for widespread use. The design involves creating a pinhole effect with a 3.23-mm central black circular mask with a 1.36-mm central aperture. 

The mask has more than 3200 microperforations to limit any negative effect on patient’s field of vision. The pinhole effect provided by this IOL may allow for good distance, intermediate vision, and potentially functional near vision. We have yet to try this IOL in practice.

Many companies are looking far past the current options of diffractive or refractive multifocal IOLs, toward what is often referred to as the “Holy Grail” of IOLs: a truly accommodating IOL. Such an IOL could change its refractive power, driven by contraction of the ciliary body—just as in a prepresbyopic human eye. Presently, the leaders are the FluidVision (Alcon), the modular Juvene (LensGen, Inc), and the JelliSee (JelliSee Ophthalmics, Inc); the first 2 of these are already undergoing human trials.

 The JelliSee claims to deliver an astonishing 6 D of true accommodation.

In addition to the careful consideration of your patient’s priorities and of the characteristics of each IOL, priority should be given to the preferences of your cataract surgeon. Many surgeons find that some multifocal IOLs work well in their hands, whereas others do not—this should be respected.

The field of presbyopia correction already includes many excellent IOLs that can offer a significant range of spectacle-free vision for a motivated patient, yet the field continues to evolve rapidly in search of lenses that offer better accommodation with less adverse effects. For a truly successful outcome, your patient must clearly understand their priorities, and you and your surgery center must understand the options.

Multifocal Intraocular Lenses: The Art and the Practice

Braga-Mele R, Chang D, Dewey S, et al. Multifocal intraocular lenses: relative indications and contraindications for implantation. 

. 2014;40(2):313-322. doi:10.1016/j.jcrs.2013.12.011

Kohnen T, Marchini G, Alfonso JF, et al. Innovative trifocal (quadrifocal) presbyopia-correcting IOLs: 1-year outcomes from an international multicenter study. 

. 2020;46(8):1142-1148. doi:10.1097/j.jcrs.0000000000000232

Alió JL, Pikkel J. Multifocal intraocular lenses: preoperative considerations. In: Alió JL, Pikkel J, eds. 

Kohnen T, Herzog M, Hemkeppler E, et al. Visual performance of a quadrifocal (trifocal) intraocular lens following removal of the crystalline lens. 

. 2017;184:52-62. doi:10.1016/j.ajo.2017.09.016

Ribeiro F,J Ferreira TB, Silva D, Matos AC, Gaspar S. Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and multifocal profiles. 

. 2021;47(11):1448-1453. doi:10.1097/j.jcrs.0000000000000659

Gabrić N, Gabrić I, Gabrić K, Biščević A, Piñero DP, Bohač M. Clinical outcomes with a new continuous range of vision presbyopia-correcting intraocular lens. 

. 2021;37(4):256-262. doi:10.3928/1081597X-20210209-01

Ferreira TB, Ribiero FJ, Silva D, Matos AC, Gaspar S, Almeida S. Comparison of refractive and visual outcomes of 3 presbyopia-correcting intraocular lenses. 

. 2022;48(3):280-287. doi:10.1097/j.jcrs.0000000000000743

Managing patient expectations is key to selecting the best lens

Jennifer Stewart, OD

Articles

Latest Updated Articles