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      Premium intraocular lenses: The past, present and future

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          Abstract

          Purpose

          To present potential benefits as well as limitations of premium intraocular lens (IOL) use, and provide insight in future of premium cataract surgery.

          Methods

          Bibliographic research was performed in PubMed/Medline database, and the most recently updated papers were evaluated. Keywords used were: premium intraocular lens, multifocal intraocular lens, toric intraocular lens, toric multifocal intraocular lens, accommodative intraocular lens, and the respective brand names.

          Results

          Multifocal IOLs provide uncorrected distance visual acuity (UDVA) of 0.03 logMAR in 82.3%–95.7% of patients and overall spectacle independence in 81%–85% of patients. Toric IOLs provide UDVA of 0.3 logMAR in 70%–95% of patients, residual astigmatism of 1 D or less is noted in 67%–88% of patients, and spectacle independence is reported in 60%–85% of patients. Toric multifocal IOLs provide UDVA of 0.3 logMAR in 92%–97% of patients, and spectacle independence is reported in 79%–90% of patients. Accommodative IOLs represent intensively developing field in ophthalmology, and the results are still variable depending on the IOL model.

          Conclusions

          Premium IOL technology and advanced surgical techniques have significantly improved postoperative visual outcomes. Future developments will potentiate development of new premium IOL designs that will provide spectacle independence and excellent visual outcomes after cataract surgery.

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          Most cited references75

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          Sources of error in intraocular lens power calculation.

          N E Sverker Norrby (2008)
          To identify and quantify sources of error in the refractive outcome of cataract surgery. AMO Groningen BV, Groningen, The Netherlands. Means and standard deviations (SDs) of parameters that influence refractive outcomes were taken or derived from the published literature to the extent available. To evaluate their influence on refraction, thick-lens ray tracing that allowed for asphericity was used. The numerical partial derivative of each parameter with respect to spectacle refraction was calculated. The product of the partial derivative and the SD for a parameter equates to its SD, expressed as spectacle diopters, which squared is the variance. The error contribution of a parameter is its variance relative to the sum of the variances of all parameters. Preoperative estimation of postoperative intraocular lens (IOL) position, postoperative refraction determination, and preoperative axial length (AL) measurement were the largest contributors of error (35%, 27%, and 17%, respectively), with a mean absolute error (MAE) of 0.6 diopter (D) for an eye of average dimensions. Pupil size variation in the population accounted for 8% of the error, and variability in IOL power, 1%. Improvement in refractive outcome requires better methods for predicting the postoperative IOL position. Measuring AL by partial coherence interferometry may be of benefit. Autorefraction increases precision in outcome measurement. Reducing these 3 major error sources with means available today reduces the MAE to 0.4 D. Using IOLs that compensate for the spherical aberration of the cornea would eliminate the influence of pupil size. Further improvement would require measuring the asphericity of the anterior surface and radius of the posterior surface of the cornea.
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            Contribution of posterior corneal astigmatism to total corneal astigmatism.

            Mitchell Weikert, Richard Jenkins, Li-Hsueh Wang … (2012)
            To determine the contribution of posterior corneal astigmatism to total corneal astigmatism and the error in estimating total corneal astigmatism from anterior corneal measurements only using a dual-Scheimpflug analyzer. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Case series. Total corneal astigmatism was calculated using ray tracing, corneal astigmatism from simulated keratometry, anterior corneal astigmatism, and posterior corneal astigmatism, and the changes with age were analyzed. Vector analysis was used to assess the error produced by estimating total corneal astigmatism from anterior corneal measurements only. The study analyzed 715 corneas of 435 consecutive patients. The mean magnitude of posterior corneal astigmatism was -0.30 diopter (D). The steep corneal meridian was aligned vertically (60 to 120 degrees) in 51.9% of eyes for the anterior surface and in 86.6% for the posterior surface. With increasing age, the steep anterior corneal meridian tended to change from vertical to horizontal, while the steep posterior corneal meridian did not change. The magnitudes of anterior and posterior corneal astigmatism were correlated when the steeper anterior meridian was aligned vertically but not when it was aligned horizontally. Anterior corneal measurements underestimated total corneal astigmatism by 0.22 @ 180 and exceeded 0.50 D in 5% of eyes. Ignoring posterior corneal astigmatism may yield incorrect estimation of total corneal astigmatism. Selecting toric intraocular lenses based on anterior corneal measurements could lead to overcorrection in eyes that have with-the-rule astigmatism and undercorrection in eyes that have against-the-rule astigmatism. The authors received research support from Ziemer Group. In addition, Dr. Koch has a financial interest with Alcon Laboratories, Inc., Abbott Medical Optics, Inc., Calhoun Vision, Inc., NuLens, and Optimedica Corp. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
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              Dissatisfaction after implantation of multifocal intraocular lenses.

              Niels de Vries, Carroll Webers, Wouter Touwslager … (2011)
              To analyze the symptoms, etiology, and treatment of patient dissatisfaction after multifocal intraocular lens (IOL) implantation. Department of Ophthalmology, Maastricht University Medical Center, The Netherlands. Case series. In this retrospective chart review, the main outcome measures were type of complaints, uncorrected and corrected distance visual acuities, uncorrected and distance-corrected near visual acuities, refractive state, pupil diameter and wavefront aberrometry measurements, and type of treatment. Seventy-six eyes of 49 patients were included. Blurred vision (with or without photic phenomenon) was reported in 72 eyes (94.7%) and photic phenomena (with or without blurred vision) in 29 eyes (38.2%). Both symptoms were present in 25 eyes (32.9%). Residual ametropia and astigmatism, posterior capsule opacification, and a large pupil were the 3 most significant etiologies. Sixty-four eyes (84.2%) were amenable to therapy, with refractive surgery, spectacles, and laser capsulotomy the most frequent treatment modalities. Intraocular lens exchange was performed in 3 cases (4.0%). The cause of dissatisfaction after implantation of a multifocal IOL can be identified and effective treatment measures taken in most cases. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
              Article 0 comments Cited 128 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jasmin Zvorničanin
                Journal
                Journal ID (nlm-ta): J Curr Ophthalmol
                Journal ID (iso-abbrev): J Curr Ophthalmol
                Title: Journal of Current Ophthalmology
                Publisher: Elsevier
                ISSN (Electronic): 2452-2325
                Publication date PMC-release: 18 May 2018
                Publication date Collection: December 2018
                Publication date (Electronic): 18 May 2018
                Volume: 30
                Issue: 4
                Pages: 287-296
                Affiliations
                [1]Department of Ophthalmology, University Clinical Center Tuzla, Bosnia and Herzegovina
                Author notes
                [∗ ]Corresponding author. Department of Ophthalmology University Clinical Center Tuzla Trnovac b.b., 75000 Tuzla, Bosnia and Herzegovina. zvornicanin_jasmin@ 123456hotmail.com
                Article
                Publisher ID: S2452-2325(17)30256-1
                DOI: 10.1016/j.joco.2018.04.003
                PMC ID: 6276729
                PubMed ID: 30555960
                SO-VID: 6015ec7c-59fc-4b09-859f-828f5bd9aa4a
                Copyright © © 2018 Iranian Society of Ophthalmology. Production and hosting by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 15 December 2017
                Date revision received : 9 April 2018
                Date accepted : 25 April 2018
                Categories
                Subject: Article

                Keywords: multifocal iol,toric iol,accommodative iol,cataract surgery
                Data availability:
                Keywords: multifocal iol, toric iol, accommodative iol, cataract surgery

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