Presbyopia: IOL Effective

A recent trifocal intraocular lens (IOL) based on one of the world’s most proven designs provides relatively seamless vision at distances from about 40cm out, and appears to reduce contrast issues seen in earlier designs, Michael Lawless MD told the XXXIV Congress of the ESCRS in Copenhagen, Denmark.

“The platform is capable of providing true spectacle independence if you get everything right,” said Dr Lawless about the diffractive, one-piece hydrophobic acrylic AcrySof® IQ PanOptix® (Alcon). Introduced at the XXXIII Congress of the ESCRS in Barcelona, Spain, the lens incorporates a +3.25D add for reading at about 40cm, and a +2.17D intermediate add peaking at about 60cm, and transmits 88% of incoming light.

Dr Lawless’ study and clinical impressions confirm previous reports that the PanOptix IOL provides continuous useful visual acuity across the full range of its correction envelope, improving on bifocal designs with poor intermediate performance. However, many patients experienced significant glare and halos, particularly early after surgery, added Dr Lawless, of Sydney Medical School, and Vision Eye Institute, Sydney, Australia.


'We’ve got to get it right for these lenses to perform correctly'

In a prospective non-randomised study involving 66 eyes of 35 patients, Dr Lawless implanted non-toric PanOptix IOLs in 28 cataract patients and 38 refractive lens exchange patients. Mean preoperative spherical equivalent was +1.31D ±1.27 ranging from -1.75D to +4.00D, with sphere ranging from -1.50D to +4.00D, and cylinder from -1.50D to 0.00D. Mean follow-up was 4.3 weeks ± 1.4 weeks, ranging from two to nine weeks.
Just over three-quarters of eyes were within 0.25D of target spherical equivalent and all within 0.5D, Dr Lawless reported. Mean post-op uncorrected distance visual acuity was 0.04 ±0.12 logMAR, or nearly 20/20, exceeding the pre-op corrected mean of 0.09 ±0.12, or about 20/25. Applying a 30-question validated survey of visual symptoms (McAlinden, IOVS 2010) to 10 patients, Dr Lawless found glare and halo symptoms were much higher than previous reports for spectacle-corrected monofocal IOL recipients at three months’ follow-up, and similar to those reported for previous multifocal IOLs.

Nonetheless, Dr Lawless sees the PanOptix IOL as a viable choice for patients seeking spectacle independence, though careful patient selection and surgery are essential. “We’ve got to get it right for these lenses to perform correctly,” he said.

Michael Lawless: michael.lawless@visioneyeinstitute.com.au