SURGEONS SHARE THEIR RESULTS

Newcomers WITH SOME OF THE LATEST IOLS

TO ENTER THE EUROPEAN MARKET.

Courtesy of Sheraz M. Daya, MD, FACP, FACS, FRCS(Ed), FRCOphth

Figure 1. The Artis Symbiose Plus and Mid lens models have complementary diffractive profiles, providing a continuum
SHERAZ M. DAYA, MD, FACP, of good vision.
FACS, FRCS(ED), FRCOPHTH

ARTIS SYMBIOSE
This complementary lens system
provides mix-and-match IOLs
by design.

I
have, over the past 6 months,
had the privilege of using a
new trifocal lens system, the
Artis Symbiose (Cristalens). The
system consists of a complementary
pair of lenses. One lens, the Plus, is
designed for increased near vision
and implanted in the nondominant Figure 2. The defocus curves—in each eye and binocularly—of an individual implanted with the Artis Symbiose.
eye. The other lens, the Mid, is
designed to provide relatively more preserving continuous phase, with At last data audit, we had
intermediate vision and implanted in none of the phase inversion or loss of performed 105 implantations of the
the dominant eye. The lens system is focus seen as troughs in the defocus Artis Symbiose, of which 50 were
different from other trifocal offerings curves of other diffractive lenses bilateral and five were unilateral
in providing depth of focus by (Figure 1). Plus lenses in patients who were

36 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | APRIL 2020

 NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

s
undergoing monocular cataract Patients were overall very satisfied, The lens system is a welcome
surgery or who had undergone and only three spontaneously reported addition to the armamentarium of
surgery elsewhere in the other eye a difference in near vision between trifocal lenses. Binocularly, the Artis
with a less-than-satisfactory result. the two eyes. All patients had good Symbiose system provides good vision
At 6 weeks postoperative, 84% were intermediate vision right away with an at all distances with what appears to
within ±0.50 D of emmetropia, and overall wow response reminiscent of be a reduced time for adaptation.
100% were within ±1.00 D. Binocular LASIK. Although halos were reported,
uncorrected distance visual acuity no patient complained about this
(UDVA) was 20/20 or better in 83% being debilitating or interfering with SHERAZ M. DAYA, MD, FACP, FACS, FRCS(ED),
of eyes, uncorrected near visual acuity the ability to drive. FRCOPHTH
n M edical Director, Centre for Sight, East Grinstead,
(UNVA) was 20/25 or better in 86% The defocus curves were interesting,
of eyes, and uncorrected intermediate in that there were no troughs with United Kingdom
n C hief Medical Editor, CRST Europe
visual acuity (UIVA) at 60 and 80 cm good vision at all distances from both
n s daya@[Link]
was 20/25 or better and 20/20 or bet- Mid and Plus lenses with a binocular
n F inancial disclosure: None
ter, respectively, both in 97% of eyes. cumulative effect (Figure 2).

for me to turn ordinary cataract with the Tecnis ZCB00 monofocal

management into an extraordinary IOL because it has the same base
experience. geometry, material characteristics,
For patients, the Tecnis Eyhance edge design, haptics, and A-constant.
adds what I like to think of as the There is no learning curve or
lost dimension—intermediate additional chair time. Surgeons
vision. Everyday activities such can be confident in the stable,
as working on a laptop or tablet, well-established Tecnis platform
playing cards, and cooking all take that does a good job preventing
place primarily at intermediate focal posterior capsular opacification,
lengths. But ophthalmologists don’t balancing out corneal spherical
have appropriate ways of measuring aberration, and retaining its clarity
intermediate vision. I am part of an after implantation.
ESCRS working group that recently
published an editorial advocating CLINICAL EXPERIENCE
RITA MENCUCCI, MD better measures of functional vision, In a recently published prospective
including intermediate function, case series, my colleagues and I
as indicators for cataract surgery.1 compared visual acuity at near
TECNIS EYHANCE I love that this lens can enhance
intermediate vision without added
(40 cm), intermediate (66 cm),
and distance (4 m) at 6 months
dysphotopsia or any loss of distance postoperative in patients bilaterally
Broader defocus curve enhances visual acuity or clarity. implanted with either the ZCB00 or
intermediate vision with this The Tecnis Eyhance offers a Tecnis Eyhance.2 We also looked at
slightly broader defocus curve than a quality-of-vision metrics.
monofocal IOL. standard monofocal IOL that allows Monocular and binocular UIVA

I
a wider sweet spot with enhanced was significantly better in the Eyhance
began using the Tecnis Eyhance intermediate vision. It does not group than the Tecnis group, while
(model ICB00, Johnson & rely on diffractive optics, rings, or distance and near visual acuities
Johnson Vision) monofocal lens zones. Rather, the broader defocus is were similar between the two groups
with enhanced intermediate achieved through an aspheric surface (Figure 3). There were no significant
vision about 1 year ago. For the with continuous increase in power differences in photopic contrast
many patients under public health from the periphery to the center of sensitivity, light scatter, modulation
systems who cannot afford or do not the lens. transfer function cutoff, Strehl ratio,
have access to presbyopia-correcting Use of this lens is an easy transition or glare and halo perception between
IOLs, this lens makes it possible for any surgeon who is familiar the groups.

APRIL 2020 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 37

s NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

demand for near vision who desire

Courtesy of Johnson & Johnson Vision

spectacle independence. In those

patients, I direct them toward a
multifocal, trifocal, or extended depth
of focus (EDOF) IOL. It is also not the
best choice for patients with signifi-
cant astigmatism, as a toric version is
not yet available. For all other monofo-
cal candidates, the Tecnis Eyhance is
now my preferred lens.
1. Ribeiro F, Cochener C, Kohnen T, et al; ESCRS Functional Vision Working
Group. Definition and clinical relevance of the concept of functional vision in
cataract surgery: ESCRS position statement on intermediate vision. J Cataract
Figure 3. The Tecnis Eyhance monofocal IOL offered statistically significantly better UIVA and distance-corrected Refract Surg. 2020;46:S1-S3.
binocular intermediate visual acuity (DCIVA) compared to the Tecnis 1-piece ZCB00 monofocal. There were no significant 2. Mencucci R, Cennamo M, Venturi D, et al. Visual outcome, optical quality
differences in UDVA or corrected distance visual acuity (CDVA) or in UNVA or distance-corrected near visual acuity and patients’ satisfaction with a new monofocal intraocular lens, enhanced
for intermediate vision: Preliminary results [published online ahead of print
(DCNVA). January 27, 2020]. J Cataract Refract Surg.

NOT A MULTIFOCAL their functional vision. It is important

The Eyhance IOL is a good option to be clear with patients that the RITA MENCUCCI, MD
for risk-averse patients or those with Eyhance is a monofocal, not a n P rofessor of Ophthalmology, Eye Clinic, University

pathology who might not be suitable multifocal, lens. of Florence, Italy

candidates for a presbyopia-correcting This lens would not be the best n r [Link]@[Link]

IOL but would still like to maximize choice for patients with a high n F inancial disclosure: None

T
he FineVision Triumf refraction of plano to -0.25 D for
(PhysIOL; Figure 4), is a two reasons.
trifocal IOL with EDOF First, we wanted the sphere to be
optical technology. I was one consistently on target to calculate a
of the first two surgeons worldwide universal A-constant. Second, we have
to implant the Triumf IOL, and I am found that a slight myopic spherical
now participating in a prospective equivalent helps patients to achieve
multicenter study of the lens. better near vision.
The Triumf is made of PhysIOL’s
proprietary glistening-free

Figures 4 and 5 courtesy of PhysIOL

hydrophobic acrylic lens material.
The overall diameter and the optic
diameter of the Triumf are 11.4 and
ROBERT EDWARD ANG, MD 6 mm, respectively, and the lens is
UV- and blue light–filtering. This
article reviews some of the early
FINEVISION results and 6-month follow-up data
on 78 eyes of 40 patients implanted
TRIUMF with the lens.
The mean age of the patients was
65.6 years. Of the 40 patients, 18 were
Improved vision and contrast Asian and 22 were white. This is
sensitivity are associated with the important because Asian eyes tend
to be more myopic, and this study
lens’ chromatic aberration-free is providing valuable information
on how the IOL behaves in both
optical design. populations. We used a target Figure 4. The FineVision Triumf IOL.

38 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | APRIL 2020

 NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

s
RESULTS
The mean monocular UDVA in “THE MAJOR DIFFERENCE IN THE DESIGN
these 78 eyes was 20/22, with 75%
of patients achieving 20/20 or better
OF THE TRIUMF, IN COMPARISON WITH THE
and 79% achieving 20/25 or better. FINEVISION TRIFOCAL IOL, IS THE HEIGHT OF
Mean monocular CDVA was 20/20,
with 11% of eyes achieving 20/16 THE STEPS IN ITS DUAL BIFOCAL ELEMENTS. ”
or better and 96% achieving 20/20
or better.
It is unusual to obtain results this —ROBERT EDWARD ANG, MD
good on a multifocal IOL platform.
We attribute these results to the
chromatic aberration characteristics
of the Triumf, which I will discuss intermediate acuities remain strong. Patients enrolled in the study
further later in this article. When the influence of the slight to date have been highly satisfied.
Mean monocular UIVA at myopia was corrected, about 75% of All patients reported spectacle
6 months postoperative was 20/23, patients still achieved 20/25 DCNVA. independence at distance and
with 46% of patients achieving 20/20 intermediate, and 95.7% reported
or better and 89% achieving 20/25 or GOOD VISION AT ALL DISTANCES spectacle independence at near. Only
better. When patients were corrected From these results, we determined 4.3% of patients reported needing
for distance, the mean UIVA was that mean visual acuity through glasses for near vision tasks some of
approximately 20/22, with 64% of all distances can be expected to be the time, and none reported needing
patients achieving 20/20 or better about 20/25. them all or most of the time.
and 89% achieving 20/25 or better. The defocus curves, based on
The mean monocular UNVA with visual acuity outcomes from distance, CONCLUSION
the Triumf was 20/25. Further, 46% intermediate, and near visual acuity We attribute the improved
of patients achieved 20/20 or better tests, showed that the lens provides vision and contrast sensitivity
and 68% achieved 20/25 or better. patients with a broad range of with the Triumf to its chromatic
This is an excellent result, showing vision (monocular: -3.20 to +1.30 D aberration-free optical design, which
that near vision is not sacrificed with [31 cm to infinity]; binocular: -3.80 to corrects longitudinal chromatic
the Triumf, even as distance and +1.50 D [26 cm to infinity]). aberration. The major difference
in the design of the Triumf, in
comparison with the FineVision
trifocal IOL, is the height of the
steps in its dual bifocal elements.
This difference in design controls
chromatic aberration. This does
not correct the natural chromatic
aberration of the eye, but it does
correct any chromatic aberration
introduced by the diffractive optic
of the IOL (Figure 5). The expected
benefit is an improvement of
visual quality and high contrast
sensitivity.

ROBERT EDWARD ANG, MD

n S enior Ophthalmologist and Head of Cornea and

Refractive Surgery, Asian Eye Institute, Makati City,

Philippines
n a ngbobby@[Link]
Figure 5. Through-focus on-bench modular transfer function curves at 50 lp/mm (data on file with PhysIOL). n F inancial disclosure: Consultant (PhysIOL)

APRIL 2020 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 39

s NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

T
he IC-8 IOL (AcuFocus; UIVA was 0.83 logMAR (20/24), and
Figure 6) combines an UNVA was 0.66 logMAR (20/30).2
aspheric monofocal IOL With respect to binocular vision,
with an embedded opaque 99%, 95%, and 79% of patients
mini-ring to simultaneously address enrolled in the trial had achieved
refractive error and presbyopia. 20/32 or better UDVA, UIVA, and
The one-piece hydrophobic acrylic UNVA, respectively.2
IOL, which has modified C-loop The majority of the 105 patients
haptics, an overall diameter of (95.9%) reported that they would
12.5 mm, a 6-mm biconvex aspheric select the IC-8 IOL again, and most
optic, and a square 360º posterior (84.8%) reported using spectacles
edge is implanted in the capsular bag occasionally to never. Binocular
at the time of cataract surgery. The contrast sensitivity matched the
embedded annular mask of the IOL monocular contrast sensitivity
has an outer diameter of 3.23 mm achieved in the contralateral eye with
and a central aperture diameter of a monofocal IOL.
1.36 mm. Patients in this study and others
have tolerated as much as 1.00 D of
WELL TOLERATED, MORE FORGIVING residual refractive error, suggesting
THAN OTHER IOLS that the small-aperture concept of
H. BURKHARD DICK, MD, PHD, The IC-8 IOL has the CE Mark, and the IC-8 IOL may be more forgiving
FEBOS-CR the company announced in June than monofocal and multifocal
2019 that enrollment for the pivotal IOLs.2 Notably, astigmatic patients
US Investigational Device Exemption in a prospective clinical trial
IC-8 study had been completed. That
12-month prospective, multicenter,
who received an IC-8 IOL and no
additional astigmatic management
nonrandomized case control clinical were able to tolerate up to 1.50 D of
Small-aperture optics provide an trial is designed to evaluate the refractive astigmatism.3
effective physiologic improvement in vision with the IC-8
IOL at all distances compared with SUITABLE FOR A BROAD RANGE OF
presbyopia-correcting traditional monofocal IOLs.1 PATIENTS
I participated in a multicenter A capsular bag implant such as the
solution for a range of postmarket European trial IC-8 IOL is suitable for a broad range
accommodation loss, regardless of the IC-8 IOL implanted in
105 patients. In that study, 6 months
of patients, including those with
irregular corneas.4,5 The implant can
of cataract status. after implantation, monocular UDVA be used in patients with naturally
was 0.87 logMAR (20/23 Snellen), occurring corneal higher-order
Courtesy of AcuFocus

Courtesy of H. Burkhard Dick, MD, PhD, FEBOS-CR

Figure 6. The IC-8 IOL. Figure 7. Intraoperative view of the IC-8 IOL after laser cataract surgery.

40 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | APRIL 2020

 NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

s
ocular lens after previous corneal refractive surgery: visual outcomes and
aberrations of 0.6 µm or more or As a result, it is important to spectacle independence. J Cataract Refract Surg. 2018;44(9):1150-1154.
after corneal refractive surgery and evaluate pupil size when considering 5. Barnett V, Barsam A, Than J, Srinivasan S. Small-aperture intraocular lens
keratoplasty. the IC-8 lens. combined with secondary piggyback intraocular lens during cataract surgery
after previous radial keratotomy. J Cataract Refract Surg. 2018;44(8):1042-
Patients with diseased corneas, 1045.
keratoconus, or ocular trauma are 1. AcuFocus completes study enrollment for U.S. IDE clinical trial of IC-8
lens. [press release]. Acufocus. June 14, 2019. [Link]
also potential candidates for this com/us/sites/default/files/MKU%20645%20Rev%20A%2C%20
technology. The majority of patients AcuFocus%20Completes%20Study%20Enrollment%20for%20U.S.%20
do well with this lens, but some IDE%20Clinical%20Trial%20of%20IC-8%[Link]. Accessed March H. BURKHARD DICK, MD, PHD, FEBOS-CR
19, 2020.
patients with larger mesopic pupils n D irector and Chairman, University Eye Hospital,
2. Dick HB, Piovella M, Vukich J, et al. Prospective multicenter trial of a
(≥ 6 mm) may experience photic small-aperture intraocular lens in cataract surgery. J Cataract Refract Surg. Bochum, Germany
phenomena due to light coming 2017;43:956-968. n M ember, CRST Europe Editorial Advisory Board
3. Ang RE. Small-aperture intraocular lens tolerance to induced astigmatism.
around the outside edge of the n b [Link]@[Link]
Clin Ophthalmol. 2018;12:1659-1664.
opaque ring. 4. Agarwal S, Thornell EM. Cataract surgery with a small-aperture intra- n F inancial disclosure: Consultant (AcuFocus)

Courtesy of PhysIOL
PAVEL STODULKA, MD, PHD,
FEBOS-CR
Figure 8. Defocus curve at 1 month postoperative.

ISOPURE 1.2.3
The lens does this by using a unique study of the IsoPure lens. Thus far,
anterior-posterior optical surface 1-month outcomes are available for
profile of increased negative spherical our study population of 19 patients
This EDOF monofocal IOL is less aberration that is fine-tuned for each (38 eyes).
diopter over the entire optic. Optical The mean age of the 12 women and
sensitive to defocus than a bench testing has shown that the seven men in the study was 69.9 years.
optical system of the IsoPure 1.2.3 We aimed for a target of slight myopia
standard aspheric monofocal IOL. is less sensitive to defocus than a in all eyes.

T
standard aspheric monofocal IOL We found no statistically significant
he recently introduced and that it offers a continuous range differences in postoperative refractive
IsoPure 1.2.3 (PhysIOL), based of vision between distance and cylinder at 1 week and 1 month
on isofocal technology, is intermediate at any pupil size. postoperative. In fact, the cylinder
an EDOF IOL that aims to decreased slightly during the first
overcome some of the limitations IN CLINICAL PRACTICE month because the incision for lens
of existing EDOF lenses, including I participated in the first implantation was created on the
unwanted photopic phenomena. multicenter prospective clinical steepest corneal meridian.

APRIL 2020 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 41

s NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

As would be expected, monocular These data show that the IsoPure CONCLUSION
UDVA improved significantly from 1.2.3 can provide high-quality UCVA As with any new technology, longer
preoperative: 45% of eyes achieved at both distance and intermediate follow-up in a larger number of eyes
20/20 or better UDVA at 1 month lengths, and our results indicate that is warranted. For now, I look forward
postoperative. CDVA was 20/20 or patients can see well from 77 cm to to using the IsoPure 1.2.3 in many
better in 89% of eyes. Also at 1 month, infinity. more patients to provide them with
monocular UIVA at 80 cm was 20/32 Also at 1 month postoperative, increased depth of focus.
or better in 56% of eyes and 20/40 or the defocus curve (Figure 8) and
better in 83% of eyes. DCIVA at 80 cm contrast sensitivity were as expected.
was 20/32 or better in 56% of eyes That is, the defocus range for visual PAVEL STODULKA, MD, PHD, FEBOS-CR
and 20/40 or better in 81%. DCIVA acuity of at least 20/32 was -1.10 to n C hief Eye Surgeon, CEO, Gemini Eye Clinics,

was also measured at 66 cm, at which 0.70 D, and contrast sensitivity for Czech Republic
distance 35% of eyes achieved 20/32 both photopic and mesopic was n M ember, CRST Europe Editorial Advisory Board

or better and 68% achieved 20/40 or within the normal range for patients in n s todulka@[Link]

better. this age group. n F inancial disclosure: None acknowledged

EDOF lenses have been found to

be associated with fewer halos and
less contrast sensitivity loss than
traditional multifocal IOL technology.1
In the overall range of available IOL
technologies, EDOF lenses appear to fit
somewhere between monofocal and
trifocal IOLs.
The Lucidis T IOL (Swiss Advanced
Vision), launched during the 2019
ESCRS meeting, is a one-piece, foldable,
multizonal refractive-aspheric bifocal
toric EDOF IOL with closed C-loop
ACHRAF LAOUANI, MD; DANY SALIK, MD, FEBO;
haptics. It is designed for capsular
AND ELIE MOTULSKY, MD, PHD, FEBO bag implantation and made of a
hydrophilic acrylic material with
26% water content.
LUCIDIS T
Eyes with astigmatism can benefit

Figures 9–11 courtesy of Elie Motulsky, MD, PhD, FEBO

from this lens’ extended depth of
focus technology.

S
pectacle independence after
cataract surgery is probably
one of the most frequently
expressed patient desires that
cataract surgeons hear preoperatively.
Many solutions are available, including
a wide range of IOL choices. EDOF
IOLs are among the new categories of
lenses we can offer patients for relief
from presbyopia. Figure 9. During Lucidis T IOL implantation, a manipulator is used in the nondominant hand.

42 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | APRIL 2020

 NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

s
removing all dispersive OVD from
about 20° before the target axis, but
we think there is no need to do so
with this lens.
Irrigation and aspiration can be
done while the IOL is aligned in the
target axis (Figure 10). When the I/A
instrument is removed, no rotation
is observed, and the IOL remains
perfectly aligned to the target axis at
the end of surgery (Figure 11).

CONCLUSION
The Lucidis T IOL seems to be
a good choice for patients with
astigmatism who want to benefit
Figure 10. The Lucidis T IOL is aligned to target axis during irrigation and aspiration. from EDOF technology after cataract
surgery. More clinical studies are
needed to show the benefits and
drawbacks of this lens. Our first clinical
impressions are quite enthusiastic. No
patient has complained of halos, and
most patients have good far vision,
often with additional comfort in near
and intermediate vision.

1. Breyer DRH, Kaymak H, Ax T, Kretz FTA, Auffarth GU, Hagen PR. Multifocal
intraocular lenses and extended depth of focus intraocular lenses. Asia Pac J
Ophthalmol (Phila). 2017;6(4):339-349.
2. Gillmann K, Mermoud A. Visual performance, subjective satisfaction and
quality of life effect of a new refractive intraocular lens with central extended
depth of focus. Klin Monbl Augenheilkd. 2019;236(4):384-390.

Figure 11. The IOL remains aligned to the target axis after the I/A instrument is removed at the end of the surgery. ACHRAF LAOUANI, MD
n R esident in training, Ophthalmology Department,

The EDOF technology of the report additional comfort at near and CHU Saint-Pierre and Brugmann Hospital,
Lucidis T IOL uses a 1-mm central intermediate distances after cataract Brussels, Belgium
aspheric zone surrounded by a surgery. Further, with the Lucidis T n A [Link]@[Link]

5-mm refractive ring. The lens is IOL we have not encountered any n F inancial disclosure: None

available in a power range from centering problems, and no rotation

+5.00 to +30.00 D and a cylinder of the IOL has been noted in our series DANY SALIK, MD
n C onsultant, Ophthalmology Department,
power range from +1.00 to +4.50 D. to date.
According to the manufacturer, the We like to inject the implant using CHU Saint-Pierre and Brugmann Hospital,
main benefit of this particular a manipulator in the other hand in Brussels, Belgium
n d anysalik@[Link]
design is to provide additional visual order to provide stability, to maintain
n F inancial disclosure: None
comfort at near and intermediate a constant IOP, and to give us the
distances.2 ability to manipulate the IOL at any
time during unfolding (Figure 9). ELIE MOTULSKY, MD, PHD, FEBO
n C onsultant, Ophthalmology Department,
CLINICAL EXPERIENCE Rotation of the IOL into position
In our experience, the Lucidis T IOL is easy. Even though the lens has CHU Saint-Pierre and Brugmann Hospital,
technology seems to allow us to meet a closed C-loop haptic design, we Brussels, Belgium
n e lmotuls@[Link]
our promises to patients. That is, most recommend rotating it clockwise.
n F inancial disclosure: None
of our patients who receive this lens Some surgeons have suggested first

APRIL 2020 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 43

s NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

Courtesy of Hoya
Figure 12. The Nanex multiSert+ preloaded IOL (right) and injection system (left).

treated with Hoya’s proprietary active The theoretical advantage of

KHIUN F. TJIA, MD
oxygen processing treatment to reduce wound-assisted implantation is the
posterior capsular opacification. That ability to use a smaller incision size,

NANEX
treatment was previously available but some preloaded systems have
only on the Vivinex platform. large tips that, for me, were not

MULTISERT+ The properties of the AF-1 material

allow the Nanex to be inserted
compatible with a 2.2-mm incision.
With both Hoya multiSert systems, I
through a cartridge tip smaller find it much easier to inject through a
The injector system and the than was previously possible. I can 2.2-mm incision. And I observe better
successfully implant the Vivinex wound integrity after injection. With
material of this IOL combine to multiSert through an unenlarged the Nanex multiSert+ system I do not
allow insertion through a very 2.2-mm incision, and now the Nanex have to perform stromal hydration of
multiSert+ is just one degree easier to the main incision, and it is consistently
small wound. insert through an incision of that size. completely watertight.

I
According to the manufacturer, the
n 2019, I had the opportunity to 1.62-mm injector tip of the multiSert+ EASE OF USE
evaluate the Nanex multiSert+ is the world’s smallest nozzle size in The ease of use of both multiSert
preloaded IOL and injection an open-loop preloaded hydrophobic devices is astounding. Preparation
system (Hoya; Figure 12). One IOL system. I believe that the nozzle by the operating assistant is
year previously, I had tested the will allow surgeons to inject the lens straightforward, but it is the feeling for
Vivinex multiSert preloaded IOL through incisions as small as 1.8 mm. the surgeon during insertion in which
and injector system (Hoya) and had this device surpasses others. Due to a
been impressed by the performance AWAY FROM WOUND-ASSISTED dual mechanical design that moves the
of this device. The feeling of control, TECHNIQUE IOL forward, the surgeon experiences
consistency, and ease of use with both After years of wound-assisted IOL total direct tactile control with an
systems were a level above any other injection techniques, I have now effortless forward plunger movement.
system I had used before. converted to a fully through-the-wound The sudden drop-off of force upon
The design and working mechanism technique. This avoids potential issues lens release that occurs with many
of the Nanex multiSert+ system with a wound-assisted technique, injectors does not occur with these.
is identical to that of the Vivinex including the specific skills required for Additionally, the unique ability
multiSert. The difference is the lens successfully using such a technique, to switch between push and screw
material. Although the hydrophobic the possibility of a failed injection, mode allows the surgeon to control
acrylic material of the Vivinex is newer, and, worse, the possibility of a trapped implantation precisely. This is useful
the material of the Nanex IOL is Hoya’s IOL unfolded halfway through the in challenging cases such as eyes with
proven AF-1 hydrophobic acrylic, and incision that cannot move forward narrow pupils and zonular weakness.
the Nanex is the first AF-1 IOL to be nor backward. Because the inserter is fully through

44 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | APRIL 2020

 NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

s
the wound, the surgeon can advance the injector is pushed against the eye, maintaining the unprecedented
the plunger slowly without risk of the position of the tip remains stable control and safety of its predecessor,
the IOL unfolding inside the incision, and cannot protrude too far into the the Vivinex multiSert.
making one feel much more in control eye or stretch the wound too much.
and at ease than with other systems.
The versatility of the multiSert CONCLUSION KHIUN F. TJIA, MD
injectors is further enhanced by the From my clinical experience, it is n A nterior segment specialist, Isala Clinics, Zwolle,

incorporation of an insert shield evident that the Nanex multiSert+ is Netherlands

designed to limit incision stretch and a best-in-class preloaded IOL injector n k ftjia@[Link]

reduce induced corneal astigmatism. system. It allows, if desired, the use n F inancial disclosure: Consultant (Beaver-Visitec

This shield also enhances control; when of incisions as small as 1.8 mm while International, Carl Zeiss Meditec, Hoya)

on its anterior surface, rather than account intermediate vision. Normally,

the concentric rings seen on most I prefer the 570 for elderly patients with
multifocal IOLs. In my experience, less intermediate vision activity and the
this translates to excellent far and NVA in younger patients, who have
near vision and a smooth transition an increased demand for intermediate
between the zones (Figure 13) for vision correction.
patients. Further, experience has The Precizon CTF’s optic is divided
shown that this lens has less diffusion into three concentric sectors. The two
of light transmission than is seen with peripheral sectors provide a 50/50
diffractive designs. or 60/40 distribution of distance
TIAGO MONTEIRO, MD, FEBO, The Precizon CTF is available in and near correction, depending on
FEBOS-CR two models (the 570 and the NVA), the IOL model, and the distribution
each with unique segment sizes, light changes among four segments in
distribution characteristics for far and each sector (Figure 14). The central
PRECIZON CTF near vision, and IOL aberrations. In the
570, light is distributed equally (50/50)
sector is dedicated to distance
correction. In total, there are 11 distinct
for distance and near. In the NVA, segments—five for distance vision and
A lens with a multisegment the central distance optical zone is six for near—within the optical zone,
optical design provides a continual larger, so that the distribution of light
is 60% for distance and 40% for near.
creating a smooth and continuous
transitional focus. This design facilitates
range of focus. This translates into a more natural a continuous defocus curve, sharpening

O
distribution of light and takes into images on the retina from infinity
ne recent improvement
in premium IOLs is the
incorporation of a continuous

Figures 13 and 14 courtesy of Ophtec

range of optical powers. The
intent behind this design is to provide
a more natural visual experience than
traditional multifocal IOLs and to
minimize unwanted optical side effects.
I have early clinical experience with
the Precizon Continuous Transitional
Focus (Precizon CTF, Ophtec), a lens
that uses a unique multiple-segment
optical design to provide patients with
clear vision at multiple distances.

SEGMENTAL DESIGN
The optic of the Precizon CTF Figure 13. The Precizon CTF provides constant progressive focus between two focal points and smaller amounts of
contains multiple segments and sectors diffused light transmission.

APRIL 2020 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 45

s NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

to intermediate focus and from

intermediate to near.

CLINICAL RESULTS
A prospective European multicenter
study of the Precizon enrolled
60 patients who were scheduled for
either cataract surgery or refractive lens
exchange.1 At 3 months postoperative,
80% of patients reported achieving
spectacle independence. Patients also
had good UCVA for near, intermediate,
and distance vision. The majority of
patients had no complaints of halos
or glare at night; about 5% reported a
variety of visual disturbances at night Figure 14. The Precizon CTF is available in two models.
during the first 3 months of follow-up.
1. Holzer M. Functional outcomes and patient satisfaction of the new Precizon
At my center, we enrolled presbyopia correction procedures. presbyopic multifocal intraocular lens. Paper presented at: the European
20 patients in the study. At 3 months With its anterior surface segmental Society of Cataract and Refractive Surgeons Annual Meeting; October 7-11,
2017; Lisbon, Portugal.
postoperative, 100% of patients were design, the lens provides excellent
within ±0.50 D of sphere target, and far and near vision with a smooth
87.5% were within ±0.50 D of their transition between zones, in essence
cylinder correction target. Further, creating a constant progressive focus TIAGO MONTEIRO, MD, FEBO, FEBOS-CR
37.5% were within ±0.25 D of sphere between focal points. Because the n H ead of the Cornea, Cataract, and Refractive

and 37.5% were within ±0.25 D of Precizon CTF mimics the eye’s natural Surgery Department, Hospital CUF Porto/Hospital
cylinder correction targets. process of accommodation, patients de Braga, Porto, Portugal
should experience only a brief period n E scola de Ciências da Saúde da Universidade do

CONCLUSION of neural adaptation. As with any IOL, Minho, Braga, Portugal

The Precizon CTF IOL represents patient selection is crucial with the n m [Link]@[Link]

a new paradigm in lens-based Precizon CTF. n F inancial disclosure: Consultant (Ophtec)

I
am always keen to add a new • Low incidence of posterior capsular
presbyopia-correcting IOL to my opacification; and
repertoire in the never-ending • For a toric IOL, a wide cylinder range
quest to improve patient and rotational stability.
outcomes and satisfaction. When I was therefore more than happy to
considering a new lens, I look for several participate in a multicenter evaluation
features: of the RayOne Trifocal Toric IOL
• An established manufacturer; (Rayner; Figure 15) prior to its formal
• A lens material with a proven
FRCOphth, CERTLRS
track record; Figures 15 and 16 courtesy of Amir Hamid, BMedSci, BMBS,
• A lens platform already
AMIR HAMID, BMEDSCI, BMBS, demonstrated to be safe and
FRCOPHTH, CERTLRS effective;
• Excellent visual performance;
• An option to have the IOL preloaded;

RAYONE
• A microincision push injector for the
IOL that supports a wound-assisted

TRIFOCAL TORIC technique;

• Low incidence and severity of glare
and halos; Figure 15. A well-centered RayOne Trifocal Toric IOL seen
A new IOL that checks all the boxes. with retroillumination.

46 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | APRIL 2020

 NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

s
TABLE. MONOCULAR AND BINOCULAR LOGMAR VISUAL
ACUITY AT DISTANCE, INTERMEDIATE, AND NEAR
Monocular and binocular logMAR distance visual acuities
Visual Acuity Monocular Binocular
UDVA
Mean ±SD 0.04 ±0.10 0.00 ±0.09
Range -0.10 ±0.30 -0.10 ±0.20
UIVA
Mean ±SD 0.01 ±0.05 -0.03 ±0.05
Range -0.10 ±0.10 -0.10 ±0.10
Figure 16. Pre- and postoperative refractive cylinder with the RayOne Trifocal in 20 eyes UNVA
of 10 patients. Mean ±SD 0.09 ±0.12 0.05 ±0.05
Range -0.10 ±0.20 -0.10 ±0.18
global launch at ESCRS Paris 2019. When I was presented with D, diopters; SD, standard deviation; UDVA, uncorrected distance visual acuity;
the specifications of the IOL, I was reassured to see that they UIVA, uncorrected intermediate visual acuity; UNVA, uncorrected near visual acuity
fulfilled all my requirements.
This multicenter pilot study involved five sites and five
surgeons in Germany, the United Kingdom, and Japan. CONCLUSION
Patients with bilateral visually significant cataract and no The RayOne Trifocal Toric IOL is a promising new
ocular comorbidity were enrolled after fully informed entry in the presbyopia-correcting toric IOL category
consent was obtained. After bilateral IOL implantation, the for surgeons. Initial results were excellent, with high
primary endpoints of the study were visual acuity, subjective levels of satisfaction among both patients and surgeons.
refraction, cylinder reduction, and surgeon satisfaction at Additionally, the RayPro digital platform (Rayner) for
3 months postoperative. The results of 20 eyes of 10 patients collecting patient-reported outcomes allows surgeons to
were available for analysis.1 continuously monitor long-term outcomes and satisfaction
among our patients implanted with this and other
RESULTS presbyopia-correcting IOLs.
Figure 16 summarizes the results. All patients were within
1. Barsam A, Butt A, Thomson P. First visual results after implantation of the RayOne trifocal intraocular lens. Poster
±0.50 D and 57% were within ±0.25 D of emmetropia. presented at: the 24th ESCRS Winter Meeting; February 21-23, 2020; Marrakech, Morocco.
Regarding astigmatism correction, 100% of eyes had 0.75 D or
less of astigmatism postoperatively, and 71% had 0.50 D or less.
More important, 90% of patients achieved monocular AMIR HAMID, BMEDSCI, BMBS, FRCOPHTH, CERTLRS
and binocular uncorrected distance, intermediate, and near n C onsultant ophthalmic surgeon and Clinical Lead for Cataract and Refractive

visual acuity of 0.1 logMAR or better (Table). And finally, all Surgery, Optegra Eye Hospital, London
surgeons reported high levels of satisfaction with the lens n A [Link]@[Link]; Twitter @DrAmirHamid

and its injector system. n F inancial disclosure: Consultant (Carl Zeiss Meditec)

EDOF TREATMENT WITH THE LIGHT ADJUSTABLE LENS

In clinical trials of the Light Adjustable Lens (RxSight), investigators reported RxSight has demonstrated the EDOF adjustability in 18 patients who underwent
excellent results with this first-of-its-kind IOL, including reduction in treated bilateral implantation of the Light Adjustable Lens. All were given EDOF
astigmatism, excellent UCVA, and a sharp reduction in residual spherical error.1 adjustments, and all achieved uncorrected distance and intermediate visual
In the initial iteration of the procedure, the Light Adjustable Lens could be acuities of 20/20 or better and uncorrected near visual acuities of 20/25 or better.2
treated postoperatively with the Light Delivery Device (RxSight) to adjust sphere
1. FDA approves first implanted lens that can be adjusted after cataract surgery to improve vision without eyeglasses in
and cylinder. Now, European surgeons have gained access to an extended depth some patients [press release]. US Food and Drug Administration. November 22, 2017. [Link]
of focus (EDOF) treatment for the Light Adjustable Lens. This treatment modality press-announcements/fda-approves-first-implanted-lens-can-be-adjusted-after-cataract-surgery-improve-vision-without.
Accessed March 19, 2020.
is also already approved in Mexico, according to Market Scope.2 2. RxSight begins initial commercialization of Light Adjustable Lens in the US. Market Scope Ophthalmic Market Perspectives.
September 26, 2019. [Link] Accessed March 19, 2020.

APRIL 2020 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 47

s NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

Figures 17 and 18 courtesy of Johnson & Johnson Vision

The Synergy combines diffractive
multifocal optics with an EDOF addition
at near. It also filters ultraviolet and violet
light, but it does not filter blue light. I
consider it to be most similar to a trifocal
lens. Compared with trifocal lenses, the
Tecnis Synergy has a more natural range
of near to intermediate vision and better
mesopic near vision (Figure 18).

NEAR GAINS Figure 17. The Tecnis Synergy IOL.

The near point of the Synergy is
a little closer than the near point of of distance vision that we have come to
FRANK T. KERKHOFF, MD, PHD trifocal IOLs, at about 35 cm. From expect from the Tecnis platform. Like
the near point through about 70 cm, the other lenses in this IOL family, the
the lens’ diffractive echelette optics material induces minimal chromatic
TECNIS SYNERGY provide a continuous range of near to
intermediate vision that patients say
aberration, and this is further reduced
by the optic design, especially in dim
feels natural. A range like this is ideal light. When the pupil expands, the
The EDOF addition improves for working-age patients who wish to diffractive pattern corrects even more
near vision without sacrificing be able to look from their desk to their
computer to a colleague a few feet
chromatic aberration, which explains
the high-quality vision patients report
distance vision. away, or for those who are shopping in low light situations. I have also

T
and cooking and need to be able to see found that the lens reduces spherical
he Tecnis Synergy IOL items on the grocery shelf or in their aberration to near zero in most eyes.
(Johnson & Johnson Vision; kitchen without constantly adjusting Of course, because it has diffractive
Figure 17) was introduced in how far away they are from the objects. optics, the Synergy still has some issues
Europe last year, and since The Synergy is relatively pupil inde- with glare and halos at night, but these
that time I have successfully implanted pendent, and, in my experience, patients photic phenomena are generally well
about 300 of them. Two of my senior report that they can still read in dim tolerated. My patients report that they
optometrists, who have decades of light. In fact, I have heard no complaints are an acceptable trade-off for the
experience and have been involved with about near vision at all. quality and range of vision.
more than 10,000 presbyopia-correcting
IOL cases each, have chosen bilateral DISTANCE AND NIGHT VISION NO TORIC YET
Tecnis Synergy lenses for their own The near-vision gains associated with The only other disadvantage of this
eyes, which I think is a testament to the the Synergy IOL have been achieved lens is that it is currently not available in a
excellence of this lens. without sacrificing the excellent quality toric version. In our refractive clinic, more
than half of patients need correction of
astigmatism, so this limits the number
of patients who are good candidates
for the Synergy lens. If a toric option
becomes available, the Synergy will cer-
tainly be the most frequently implanted
presbyopia-correcting IOL in my clinic.

FRANK T. KERKHOFF, MD, PHD

n C hairman, Ophthalmology Department, Maxima

Medical Center, Utrecht University, Veldhoven,

Netherlands
n f rank@[Link]

n F inancial disclosure: Paid scientific advisor

Figure 18. The Tecnis Synergy IOL offers a natural, continuous range of vision from near through intermediate, as well
as high-quality distance vision (data on file with Johnson & Johnson Vision). (Johnson & Johnson Vision)

48 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | APRIL 2020

 NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

s
Courtesy of Edoardo Ligabue, MD
maculopathy or glaucoma, and a
good tear film. For a long time, there
wasn’t much problem choosing
the right IOL because most IOLs
were monofocal. They were not
often associated with issues such as
glare, low contrast, and other visual
disturbances.
Now, the AcrySof IQ Vivity IOL
(Alcon; Figure 19) is providing vision Figure 19. The AcrySof IQ Vivity IOL.
like that of a monofocal IOL, with clear
visual acuity at a range of distances, The Vivity does not use diffractive
EDOARDO LIGABUE, MD without the drawbacks of existing or refractive technology to provide
multifocal IOL technologies. This presbyopia correction. Instead, the
innovation provides a newfound lens uses Alcon’s novel X-Wave
VIVITY stability in IOL selection and new
possibilities in visual correction.
technology, which is completely
different from the technologies
used by all other IOLs in the market.
Natural vision at a range of NATURAL VISION The X-Wave technology creates an
distances provided by a novel From my first experience with
the Vivity, its distinguishing features
extended focal range by stretching
and shifting the wavefront, as
optical technology. have been its ease of use and a visual opposed to splitting the wavefront

R
disturbance profile like that of a into multiple focal points as
ecently, the increasing number monofocal IOL. In my experience, diffractive multifocal lenses do.
of advanced-technology IOLs patients with the Vivity have natural By using all available light, this IOL
available for the correction of vision with a continuous extended maintains the same vision quality as
presbyopia and astigmatism focal range from distance to a monofocal IOL: excellent distance
has changed my approach to patient intermediate (66 cm) to functional vision, intermediate sharp vision for
management. In my practice, I need to near; in bright light, they can easily active lifestyles, and good quality vision
understand a patient’s visual needs in read up to J3, and they report high for close-up daily activities (Figure 20).1
order to provide him or her with the satisfaction.
best surgical treatment. The Vivity is pupil-independent CLINICAL EXPERIENCE
Every decision requires consider- and is not affected by angle kappa. The results shown in Figure 20, from
ation of the patient’s ocular health Contrast sensitivity, distance visual the first clinical studies of the AcrySof
status, including the presence of acuity, glare, and night vision quality IQ Vivity, are in line with the results I
regular astigmatism, the absence are comparable to the characteristics have seen with my patients in my first
of pathologic conditions such as of a monofocal IOL. 4 months implanting the Vivity.

A
Courtesy of Alcon
B

Figure 20. Uncorrected vision (A) and visual disturbance (B) results from a prospective, randomized, parallel-group, patient and assessor masked, multisite trial of 107 patients bilaterally
implanted with the AcrySof IQ Vivity IOL and 113 with the AcrySof IQ IOL with 6-month follow-up. AcrySof IQ Vivity Alcon data on file (TDOC-0055576, March 29, 2019).

APRIL 2020 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 49

s NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

When I propose a diffractive IOL and it does not impair visual acuity experience to date, the AcrySof IQ
to my patients, I always ask them in patients with maculopathies or Vivity IOL will soon become the first
if they can accept loss of a little bit glaucoma. The lens provides stability in IOL choice for most of my patients. It
of distance visual quality to gain the capsular bag and is tolerant to slight has changed the game by improving
independence from spectacles. But decentration. The Vivity is also available patients’ visual performance, making
when I discuss the Vivity IOL, offering in a toric IOL model, allowing patients my job easier and more relaxing.
excellent distance visual quality with to achieve astigmatism correction at 1. Data on file. Alcon.
occasional spectacle use to read small the time of cataract surgery.
text, the choice is unanimous: Quality
of vision is patients’ chief preference. CONCLUSION EDOARDO LIGABUE, MD
The AcrySof IQ Vivity allows me The Vivity is commercially available n C hief, Ophthalmology Department,

to have no worries about refractive in selected European markets at Centro Diagnostico Italiano,
outcomes. In my experience, it is present. Availability in additional Milan, Italy
forgiving regarding biometric accuracy, countries will follow throughout 2020, n e [Link]@[Link]

it is not sensitive to tear film variations, according to Alcon. Based on my n F inancial disclosure: None

and reduced contrast sensitivity in directly affects the optical quality of

exchange for spectacle independence. the image delivered to the retina.3
Although the benefits outweigh
the risks for many patients, the CLINICAL RESULTS
relatively high cost of premium Clinical trials with the xact
IOLs can exacerbate some patients’ Mono-EDOF IOL have taken place at
dissatisfaction and lead to secondary several sites in Europe, including clinics
surgery and IOL explantation.1 in Germany, the United Kingdom,
A new entry in the field of France, and Portugal. The largest body
presbyopia correction seeks to of data to date has been provided by
minimize risk by delivering quality the International Vision Correction
of vision and contrast sensitivity Research Centre at the University of
comparable to those of a monofocal Heidelberg, Germany.
IOL while providing an extended In the Heidelberg study of the
depth of focus with very low incidence xact IOL, for which I am the medical
of halo and glare compared with other monitor, 44 eyes of 25 patients
diffractive EDOF lenses. (10 men and 15 women) have been
The xact Mono-EDOF IOL (Santen), followed for 9 months.4 The mean
a one-piece lens manufactured from age of patients is 70.3 years, and their
MARK PACKER, MD, FACS, CPI a glistening-free hydrophobic acrylic mean preoperative monocular BCVA
material, meets international bench
Figures 21 and 22 courtesy of Santen
testing criteria for a monofocal IOL
XACT MONO-EDOF and has received the CE Mark as
a monofocal IOL. Its optic, which
This lens acts like a true monofocal incorporates four diffractive rings
(Figure 21), demonstrates a single,
while providing a continuous focus broad through-focus modulation
transfer function (MTF) peak. In
from distance to intermediate. comparison, traditional EDOF

T
IOLs exhibit dual peaks.2 MTF
he ongoing quest for the measurements and retinal image
perfect presbyopia-correcting modeling show that the xact IOL
IOL has led to a series of has a higher tolerance to tilt and
compromises involving the decentration than other EDOF IOLs
trade-offs of multifocal dysphotopsia with at least 40% higher MTF. This Figure 21. The xact Mono-EDOF IOL.

50 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | APRIL 2020

 NEW IOLS: PRESBYOPIC SOLUTIONS AND TORIC UPDATES

s
“THE XACT MONO-EDOF
IOL IS AN EXCITING
ENTRY IN THE FIELD OF
PRESBYOPIA-CORRECTING
IOLS, PROVIDING QUALITY
OF VISION SIMILAR TO
THAT OF A MONOFOCAL
IOL WITH VISION IN
Figure 22. Defocus curves demonstrate 1.30 D binocular defocus at 20/30 and a broad peak within the range of ±0.50 D
THE INTERMEDIATE
postoperative manifest refraction spherical equivalent (data on file with Santen). RANGE LIKE THAT OF
was 0.33 ±0.16 logMAR (equivalent expect binocular UDVA of 20/20
AN EDOF IOL.”
to 20/40-). or better within the dioptric range
At 9 months, mean monocular of ±0.50 D postoperative manifest —MARK PACKER, MD, FACS, CPI
BCVA improved to -0.05 refraction spherical equivalent.
±0.13 logMAR (20/20+), and Testing with the Halo and Glare
mean monocular UCVA was Simulator (Eyeland Design Network)
1. Packer M. Enhancements after premium IOL cataract surgery: tips, tricks,
0.05 ±0.19 logMAR (20/20-). demonstrated only slight interference and outcomes. In Starr C, ed. Current Ophthalmology Reports. New York:
Monocular DCIVA at 66 cm was from dysphotopsia. Approximately Springer Science + Business Media; 2013.
2. Spalton DJ, Packer M, So Y, Tiwari N, Venkateswaran K. Optical and
0.21 ±0.11 logMAR (20/30-), and 75% of patients reported little clinical comparison of a novel monofocal extended-depth-of-focus IOL and a
monocular UIVA at 66 cm was difficulty driving at night. Contrast conventional bifocal extended-depth-of-focus IOL. Paper presented at: ASCRS
Annual Meeting; May 4, 2019; San Diego, CA.
0.18 ±0.13 logMAR (20/30+). sensitivity measured within the 3. Spalton DJ, So Y, Tiwari N, Venkateswaran K. The effect of tilt and decentra-
With binocular testing, DCIVA was expected range for monofocal IOLs. tion on a novel extended-depth-of-focus IOL compared to conventional
extended-depth-of-focus IOLs. Paper presented at: ASCRS Annual Meeting;
logMAR 0.09 ±0.13, and UIVA was May 4, 2019; San Diego, CA.
logMAR 0.08 ±0.10 (20/25+). CONCLUSION 4. Weindler J, Baur I, Son HS, et al. Prospektive klinische Studie mit einer neuen
monofokalen Intraokularlinse mit erweiterter Tiefenschärfe. Paper presented
Monocular and binocular defocus The xact Mono-EDOF IOL is at: Kongress der DGII; February 13, 2020; Mainz, Germany.
curves are shown in Figure 22. Binocular an exciting entry in the field of
depth of focus at 20/30 is estimated to presbyopia-correcting IOLs, providing
be 1.30 D. Of note, the defocus peak quality of vision similar to that of MARK PACKER, MD, FACS, CPI
demonstrates a broad area within the a monofocal IOL with vision in the n P resident, Packer Research Associates

range of ±0.50 D where visual acuity intermediate range like that of an n m ark@[Link];

is better than 20/20, suggesting a EDOF IOL. Early clinical results suggest Twitter @mpackermd
relatively forgiving tolerance to normal that this lens will be a valuable n F inancial disclosure: Advisor (Advanced Vision

variations in the accuracy of IOL power addition to cataract surgeons’ Science [Santen], Alcon, Amaros Medical,
calculation. One would therefore repertoire of lenses. n Aquea Health, Bausch + Lomb, Cassini
Technologies, ClearSight, International Biomedical

TRIVA-AA Devices, Keranova, Lensar, LensGen, PhysIOL,

Precision for Medicine, Promedica International,
Rayner, Refocus Group, STAAR Surgical, Tarsus
HumanOptics received the CE Mark in February, granting approval in the European market for its trifocal Pharmaceuticals, Visant Medical); Equity owner
Triva-aA IOL. According to the company, the optimized design of the Triva-aA enables patients to enjoy good (Aerie Pharmaceuticals, Amaros Medical,
vision at near, intermediate, and distance and is particularly suitable for performing screenwork including the Aquea Health, Cassini Technologies, Digital
use of tablets and smartphones. Surgery Systems, International Biomedical
The Triva-aA is produced with high-precision sub-nano resolution technology, requiring appropriate Devices, Ira, Keranova, LensGen, Refocus
ultra-precision lathes. According to the company, this feature makes subsequent polishing superfluous. Group, STAAR Surgical, Tarsus Pharmaceuticals,
TrueVision, Visant Medical)

APRIL 2020 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 51