Reviewing key Presbyopia-Correcting IOL trends from the ESCRS Clinical Survey

Surgeons believe over 85% of their presbyopia-correcting IOL patients are satisfied with their vision at all distances

Figure 1

By far, when surgeons implant presbyopia-correcting IOLs (PCIOLS) in their cataract patients, they favour trifocal options according to results of the 2017 ESCRS Clinical Survey of Presbyopia. When asked what technology they are most interested in integrating in the next five years, trifocal/quadrafocal lenses topped that list, together with extended-range-of-vision multifocals. These answers also align with the preferences and practice patterns of Francesco Carones MD, the medical director of Carones Ophthalmology Center, Milan, Italy. “The two major categories I use are extended range of vision (ERV) and trifocals; about half and half,” he said. When surgeons were asked what percentage of their current cataract procedures, for those who are candidates, involve PCIOLs, the average is 9%. Among the presbyopia-correcting IOL procedures performed, an average of 15% involved a toric PCIOL. “I have a fully private practice, so my percentage of PCIOL procedures is 65% to 70%, Dr Carones noted. “Many surgeons in the European Union may not have the option of using the lens as there is no possibility to charge patients for the technology. For me, it is customary that I explain to them that I correct presbyopia and astigmatism at the time of surgery.” ESCRS Delegates identified light-adjustable IOLs and shape-changing implants as other technology of future interest (Figure 1). The survey was administered onsite at the annual meeting in Lisbon, Portugal, and available to be taken online. Of the almost 1,900 respondents, close to 60% have been in practice for more than a decade.

Figure 2

SATISFACTION AT ALL DISTANCES It has often been repeated that cataract patients are increasingly savvy, expecting that advanced technology will provide them with “refractive surgery-like outcomes” after cataract surgery. ESCRS members were asked about their patients’ overall satisfaction with their near, intermediate and distance vision at one year following PCIOL surgery (Figure 2). More than half of the surgeons said that their patients were somewhat satisfied with their near, intermediate and far vision. Almost 40% reported that patients were extremely satisfied with their near vision, and around 30% were extremely satisfied with intermediate and distance outcomes. “I believe to offer a truly refractive procedure, I need to be obsessive about satisfaction and conducting patient surveys,” said Dr Carones. “What I am really looking for is if the technology I selected for the patient meets his or her expectations. Even among the major PCIOL categories, there are differences in performance. I want to ensure that I assign patients to the specific IOL that I have learned is the best lens for them. I consider 90% or higher satisfaction as a good result.” His portfolio of ERV implants includes Symfony (Johnson & Johnson Vision), AT.LARA (Zeiss), and Mini WELL (SIFI MedTech); for trifocal lenses, Dr Carones prefers the AT.LISA (Zeiss) and AcrySof IQ PanOptix (Alcon). Another option in the ERV category is the small-aperture IC-8 IOL from AcuFocus, and PhysIOL’s FineVision is a popular trifocal implant.

Figure 3

RESIDUAL ERROR To understand the delegates’ practices regarding residual astigmatic error in PCIOL patients, the survey asked about the ideal outcome for amount of residual astigmatic error and what amount they believe they can achieve on a regular basis. More than 50% said astigmatism <0.50D is an ideal outcome and that they can achieve it more than 50% of the time (Figure 3). Almost 20% said <0.25D residual astigmatism is ideal, with only about 14% responding that this is realistic to achieve on a regular basis, however. “When doing presbyopia correction, the surgeon should hit plano to give patients the best result,” Dr Carones said. “Even for 0.50D of astigmatism, I implant a toric PCIOL.” On average, the delegates said that in PCIOL patients, the lowest amount of postoperative residual cylindrical error that they consider visually significant, or likely to have an impact on visual quality and satisfaction, is about -0.62D. The average spherical deviation from the intended target ESCRS surgeons consider to be visually significant is +0.61D. CONCLUSION According to a global IOL report from Market Scope, in 2017, the use of PCIOLs globally grew by more than 10%. Technological innovations will help drive revenues to more than $6.1 billion by 2023 worldwide.1 Overall, surgeons implanted nearly 27 million IOLs last year, “but postoperative refractive surprises and optical disturbances persist and often leave patients unsatisfied”, the reported noted. Adjustable implants that allow for postoperative fine-tuning of the IOL’s refractive power are projected to provide surgeons more confidence in providing accurate and customisable refractive outcomes. Market Scope predicts that the next generation of shape-changing accommodating IOLs will also play in expanding role in the adoption of PCIOLs. For Dr Carones, a “more perfect” IOL would be an extended-range-of-vision lens with improved near performance, or a trifocal with enhanced quality of vision at night. For now, however: “The current generation of IOLs are performing quite well,” he said. “We have reliable technology that can be widely used.” Francesco Carones MD, is the Cofounder and Medical Director of the Carones Ophthalmology Center, Milan, Italy. He may be reached at fcarones@carones.com. 1. Doughty M. Market Scope. Patient demand for better vision will drive double-digit growth in IOL revenues. 2018 IOL Report: A Global Market Analysis for 2017. www.market-scope.com.