Update in intraocular lenses

Update in
intraocular lenses
DR. ALVARO RODRÍGUEZ RATÓN
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016

Historical Evolution
0
50
100
150
200
250
300
350
1949 1970 1990 2015
Number of available IOL

298 available IOL at ULIB
Colaborative online free resource
TAKE HOME MESSAGE
ULIB
http://ocusoft.de/ulib/c1.htm

Main IOL characteristics
Optical features Determines
Refractive power Defocus (myopia/hyperopia)
Asphericity LSA (Longitudinal Spherical Aberration)
Toricity Astigmatism
Multifocality Distance-independent VA
Platform Design Determines
Material Biocompatibility, glistening
Border Design PCO
Haptic Refractive stability, rotation

Platform and Toricity
Variable cylinder correction range
Platform stability
Controlled 1 year follow up (SN6AT, 100 eyes)
◦ Final axis-intented axis 3.2±3 ( 1>15º)
◦ Relocation needed 1%
ANSI standard for stability (≥ 90% of eyes with ≤ 5° of rotation between visits)
TAKE HOME MESSAGE
Toric IOL
Great rotational stability

Multifocal IOL. Defocus curve
1. Best distance corrected VA (logMAR)
2. Defocus = variable distance simulation
-0.10
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0.30
0.40
0.50
0.60
0.70
0.80
0.90
-4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5
<30years
Monofocal IOL
Bifocal IOL
Trifocal IOL

Multifocal designs
REFRACTIVE
DIFFRACTIVE

Refractive multifocal IOL
+3.00D

MplusX refractive map
(NIDEK OPD3 Aberrometer)
DR. ALVARO RGUEZ. RATÓN. SECOIR 2014

Refractive multifocal IOL:
mPlus Vs mPlus X
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
0.45
-4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5
Mplus
MplusX

Diffractive multifocal IOL
Step design
◦ Wide determine focal length
◦ Height determines light energy
Counterpart
◦ Glare and Halo increase1
◦ Decrased Contrast Sensitivity2
1BJO. 2015. Visual outcomes in eyes with a distance-dominant diffractive multifocal intraocular lens with low near addition power. Hayashi K
2Aberration and contrast sensitivity comparison of aspherical and monofocal and multifocal intraocular lens eyes. Clin Exp Ophthalmol. 2007
One-step structure: Bifocal Design

Trifocal diffractive IOL
Combining two bifocal structures
◦ Constructive interference between
near add of both structures
◦ Intermediate 2nd order interferes with near
second order
◦ Creates an intermediate focus
without optical quality loss1
1Comparative analysis of the visual performance after cataract surgery with implantation of a bifocal or trifocal diffractive IOL. JRS 2014
Two structures: Trifocal Design
0
1
2
3
4
5
6
A B C D E
TRImedia
ZMB
*own data

Bifocal difractive IOL
optimizing the near add
1Clinical Outcomes Following Implantation of Diffractive Multifocal Intraocular Lenses With Varying Add Powers
2IOVS 2015. Halo and Through-Focus Performance of Four Diffractive Multifocal Intraocular Lenses.
Near Visual Quality
outperforms +4.00 Tecnis1
+2.50 Restor and LISA TRI2

Bifocal difractive IOL
optimizing the near add
1Clinical Outcomes Following Implantation of Diffractive Multifocal Intraocular Lenses With Varying Add Powers

But still bifocal IOL…
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0.40
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0.60
-4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5
Bifocal IOL
Trifocal IOL

Trifocal difractive IOL
getting the best at all distances
1. Zeiss LISA TRI
2. Alcon PANOPTIX
3. PhysIOL FINEVISION

Zeiss LISA TRI
Pupil independent
◦ Loss of optical quality at bigger pupils1
Central 4.3mm trifocal design
◦ Bifocal periphery
1Invest Ophthalmol Vis Sci. 2015. Halo and Through-Focus Performance of Four Diffractive Multifocal Intraocular Lenses. Vega F

Alcon PANOPTIX
Central 4.5mm trifocal design
◦ Monofocal periphery
EnLighEn design
◦ Non apodized
◦ High distance and intermediate light energy
◦ Lower loss of light energy (12%)

PhysIOL FINEVISION
100% trifocal optic
Convoluted
◦ Apodized
◦ Reduces step height
Platform
◦ Micro
◦ Pod
BMC Ophthalmol. 2015. Visual outcomes after bilateral trifocal diffractive intraocular lens implantation. Carballo-Alvarez J

Differential characteristics
ZEISS
AT LISA TRI (0-32)
ALCON
PANOPTIX (13-34)
Finevision
Micro (10-35)Pod(6-35)
Intermediate (D) +1.66 +2.17 +1.75
Near (D) +3.33 +3.25 +3.50
Distance Light Energy 42.85% 44% 43%
Intermediate Light Energy 17.14% 22% 15%
Near Light Energy 25.71% 22% 28%
Lost Light Energy 14.3% 12% 14%
Matherial Hydrophilic (25% water)
hydrophobic surface
Hydrophobic1,2 Hydrophilic (25% water)
LSA (μm) -0.09 -0.20 -0.113
Diameter Optic 6 mm
Plate 11 mm
Optic 6 mm
Total 13 mm
Optic 6.15mm (6)
Total 10.75mm (11.4)
Difractive system Smooth Micro Phase EnLighten Convoluted
1Evaluation of loss in optical quality of multifocal intraocular lenses with glistenings. JCRS 2016
2 Lens epithelial cell growth on the anterior optic of 2 hydrophobic intraocular lens models. JCRS 2016
3Clinically Relevant Optical Properties of Bifocal, Trifocal, and Extended Depth of Focus Intraocular Lenses. JRS 2016

LISA TRI / PANOPTIX / FINEVISION
BCVA 3 foci
(logMAR. Distance/Intermediate/Near)
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
6m 66cm 33cm
TRILISA
PANOPTIX
FINEVISION
*own data

Defocus curve
LISA TRI / PANOPTIX / FINEVISION
0.00
0.10
0.20
0.30
0.40
0.50
0.60
-3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1
MediaTRI
Panoptix
Pod
*own data

Monofocal control / LISA TRI / PANOPTIX / FINEVISION
Contrast Sensitivity Test
(Vistech, mesopic)
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
1 2 3 4 5
SA60AT
TRI LISA
Panoptix
Pod
*own data

Photic phenomena
*own data: 10 patients/group: LISA - 2 eyes (1 patient) / PAN - 0 / F - 0

Photic phenomena
208 eyes implanted TRISA TRI1
◦ 20% halo
◦ frecuent
◦ persistant
FINEVISION
◦ No Halo report 2,3
Comparative study4
1Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens. JCRS 2016
2Visual outcomes after bilateral trifocal diffractive intraocular lens implantation. BMC Oph 2015
3Visual and refractive outcomes after implantation of a fully diffractive trifocal lens. Clin Ophthalmol. 2012
4Comparison of visual outcomes of 2 diffractive trifocal intraocular lenses. JCRS 2015
LISA TRIFINEVISION

Difractive trifocal IOL
strength and weaknesses
Strength Weaknesses
Zeiss LISA TRI Optical performance Halos
Plate
Hydrophilic
Alcon PANOPTIX C-loop platform
Hydrophobic
Low near performance
Physiol FINEVISION Optical performance
Low Halo
Hydrophilic

Conclusions
1. Wide portfolio of IOLs; shared constants (ULIB)
2. Toric IOL show great rotational stability despite of chosen platform
3. Multifocal IOL
◦ Refractive depend on pupil size and centration
◦ Difractive designs
◦ Bifocal – VARIABLE NEAR ADITION
◦ Trifocal – VARIABLE DESIGN AND PLATFORM

THANK YOU
Presentation available at www.alvarorodriguezraton.com

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