Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, my name is Eric Donenfeld. I'm a clinical professor of Ophthalmology at NY U with a strong particular interest in cataract surgery and modern IO LSI. Wanna thank you med all ophthalmology for helping us with this presentation. I do consult with a variety of different companies which you see listed here. The learning objective for this talk is to counsel patients on Presbyopia correcting IO LS to talk about safety efficacy and performance, to support competence decision making by allowing by aligning trial outcomes and by integrating structured approaches to help patients feel informed, reassured and aligned with their chosen treatment plan. So this is a dilemma that many physicians and patients have when they come in for cataract surgery is what I OL should I choose for my cataract surgery? Well, there are many lenses that are adjustable for, for patients who really aren't certain. I like the light adjustable lens. I think this is a remarkable lens. It's a lens that uh is inserted like any routine lens. It's a three piece lens that goes into the bag but can be placed in the sulcus as well. So it's very good for complex surgery and what this lens gives us is the ability to titrate the refractive results postoperatively. So you can actually go back and adjust visual acuity. Um not only changing the sphere but changing the cylinder. So for patients who want monovision or patients who've had previous LASIK, where I ol calculations are more difficult. This has really become my go to intraocular lens for cataract surgery. Uh The surgery is uneventful like normal surgery and then postoperatively. Uh these patients come in about three weeks after surgery for their adjustments and then they lock in at uh six weeks postoperatively. Uh These lenses require several visitations and they require that the patient wear UV glasses when they're outside until the patients lock in these adjustable lenses work by uh adjusting the um shape of the lens by using an adjustment beam. The new lens has an active shield that blocks UV light except during the therapy. But we still recommend the use of sunglasses, POSTOP in the patients who provided these lenses. Um The light is shined to the eye. Um The photo polymerization takes place, there's diffusion and power change, changing the shape of LS. Not only can you change sphere, you can change cylinder, so you can take a patient who says I don't want monovision and then postoperatively, you can actually give them monovision postoperatively and then you finally lock in usually about six weeks afterwards. At which time, uh the patient can go out with UV light exposure without any, any issues. So let's start by talking about what's new in Presbyopic tracheal lenses. There are basically four different forms of eye walls that r that vary based on the range spectrum. We have the minimal range spectrum which is a mono focal lens. That's the government issue lens that's usually provided uh by most doctors. Uh you have a mono focal plus which is a lens that's not quite giving you enough to be called an ed off lens. But it gives you a moderate range of vision. You have the off lenses which are premium lenses here in the United States. They give you an increased range of vision, usually with very little dysphotopsia and then you have the full range of vision, multifocal eye walls that give patients distance, intermediate and near. But there is often a qualitative loss of of vision in these patients who complain of dimness or halos around lights. What I've learned and experience having dealt with multi focal IO LS for decades is that when patients want a preop solution, they expect near, but they demand distance. And the rate limiting step to most multifocal IO LS is quality vision. If this patient could read beautifully but couldn't drive at night, they certainly wouldn't be happy. And the challenges with diffractive optics are dysphotopsia. Some light is misdirected and not focused on the on the retina. The not focused light creates disturbances and this can be very problematic in low light conditions such as driving at night. In addition, there's a loss of quality of it and contrast loss, the split um light redo redo results in a reduction in light intensity leading to a decrease in contrast sensitivity. And it's difficult to see clearly in low light situations. So how do we resolve these issues that patients present with? Well, one of the things that I've learned is that the laws of optics cannot be changed and the physical optics basically say that light is diffractive. And uh according to the economist Milton Friedman, there's no such thing as a free lunch. And the same thing applies to ophthalmology. There's no free lunch in intraocular lenses. Anything we get, we have to give up something different. What I learned over a decade ago was that low, a multifocal a are better tolerated by people. And this is the study uh from the FDA that looked at three different lenses. This was the FDA approval uh trial uh of the Johnson and Johnson tetanus lenses looking at the 40 ad, the 3.25 ad and the, and the 2.75 ad. And what we found was that patients who had the lower A were much more likely to have the lens again, 97% versus 87%. And we looked at the alcon lenses exactly the same thing was seen with the alcon restore that the three lenses patients who were happier with was again, they had less dysphotopsia and that brought us to the next group of lenses which were in really invented just a couple of years ago, which are the extended depth of focus lenses. These lenses give a half a doctor or greater um reading over a monofocal control uh and their best corrected distance visual acuity is non inferior to a mo monofocal lens. So it basically gives very similar lens to a monofocal lens. But visual disturbances are not included. The first ed off lens that was shown to have the same best corrected visual acuity as a monofocal was a symphony lens. Uh This lens had an elongated focus. Um We found that this lens tends to have a spider vision or a little bit more halo and glare. But in general, it's much better tolerated than the multifocals. They updated this lens by adding a chromatic technology, reducing chromatic aberration, which improved the lens even more the lens that has become the most popular op lens to date is the ACS soft IQ vivy. Uh This stretches the wavefront of patients and gives a transition zone. Uh and it's very well tolerated by most patients. It gives you 0.53 Diop additional reading over uh a conventional lens. And you can see that the focus curve is uh moderately elongated. So these patients will say they have nice midrange and they feel very comfortable doing mid-range tasks. They can't really read up close unless you do monovision. But the midrange vision is markedly improved and spectacle independence. Obviously, here is much greater. It's certainly not 100% only 21% but much greater than a monofocal control binocular visual acuity again, very similar to a monofocal lens. Now, the next lens that uh became available is not an off lens. This is a mono plus lens and this was the eye hands lens, which is a lens that gives you a little additional reading. It's not a premium lens, but it doesn't cross that threshold of 0.5 diopter. It's visually indistinguishable from the ZC Boo tetanus lens and it has the same um chromatic dispersion, spherical aberration and a constant. But what it does do, it does give you a little bit more mid-range vision. Uh patients like it very much, it looks very similar to the vivy lens. I find the quality of vision to be actually superb with this lens. And patients will almost always say that they have very good distance vision and they can do some midrange as well. The disc at tops you um profile is very similar to the tetanus one piece. Um And this is a paper that I presented this past year at the European Society of Cataract Refractive Surgery. Looking at almost 1500 patients who had cataract surgery with the eye hands who are monofocal control. And, and what it shows very nicely is that the patients who got the ZC Boo, the monofocal lens had a little bit better distance vision. 45% of the patients see 2016 versus 33%. So you do lose a little bit of distance vision with this lens not a lot. Uh The P value is very small but what they gain in return is a markedly improved uncorrected intermediate vision. 17% of the patients seeing 2016 versus 3% of the control. And you can see here uh 2020 visual QTY.