"Clareon IOL Next Generation"

"Posterior capsule opacification (PCO), may significantly affect the vision of patients with multifocal IOLs sooner in its progression than patients with monofocal IOLs."

I wonder why that would be the case?

Bookwoman, I'm going to guess that the answer is you're already splitting the incoming light into multiple images, with each one getting a fraction of the total photons, and losing contrast as a result. Now if you reduce the illumination level, clarity and contrast of the incoming light with PCO, you will notice it sooner if the image you are paying attention to at any given moment is formed with only a fraction of the incoming light to begin with due to multifocality than if it makes use of all the available photons, as in a monofocal..

That makes sense, thanks.

I am not entirely sure what difference it makes that the article is an Alcon-sponsored supplement to CRSToday (Cataract and Refractive Surgery Today). The authors clearly state they are Alcon consultants. Nor am I entirely sure what difference it makes that CRSToday is not a peer-reviewed publication. If you search "CRSToday About" a Linked In profile states "Cataract & Refractive Surgery Today keeps surgeons up to date on the latest technologies and techniques through educational articles on surgery and practice management. CRST provides coverage of topics that matter most to surgeons." It is practice magazine for ophthalmologists, not a technical journal.

Indeed, if you browse current and past issues there many such articles, written by a number of esteemed ophthalmologists from around the world. They cover a wide range of topics from glaucoma to astigmatism. Some of the cataract surgeons state they use both Alcon and Johnson and Johnson products. If you Google " CRSToday New technologies I'm using in 2021," it takes you to a CRSToday article by Dr. Roberto Pineda, Chair in Ophthalmology at the Massachusetts Eye and Ear Infirmary, in which he states, " I am looking forward to offering the Eyhance."

In the Sept. 2023 edition of CRSToday, Dr. Joaquin Rojas in "Adopting a Refractive Mindset," praises the Eyhance. In the September 2023 edition of CRSToday Europe, there is a Johnson and Johnson supplement about the Tecnis Synergy.

I think readers can draw their own conclusions about CRSToday.

Article is https://crstoday.com/articles/clareon-iol-the-next-generation/clareon-iol-the-next-generation-3 I think.

I think RebDovid's cautions were reasonable, and I for one benefited. That "According to its “About” webpage: “CRST is a targeted, cost-effective vehicle through which industry can aim marketing/advertising messages to cataract and refractive surgeons." was particularly enlightening to me, and probably a few others.

He was not saying that the article was more biased than others, and did not imply that the article was untrue. Just that things often be taken with a grain of salt, and other information should be pursued

also, along the same topic, https://www.ophthalmologytimes.com/view/ascrs-2023-new-head-to-head-data-show-monofocal-iols-provide-similar-range-of-vision is fairly new. It may duplicate other documents.

I have seen that "2.5 letter mean difference" phrase before. I felt that 2.5 letters is significant.

Your posting was very useful also.

I agree that readers can draw their own conclusions about articles in CRST. And I'm not suggesting that articles be disregarded because they're not subject to peer review. But for reasons I'll explain, as a reader I give greater presumptive weight to articles that have gone through the peer review process. And I give lesser weight to articles that a product's manufacturer pays to have published in (what amounts to) an advertising supplement.

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Why might other readers join me in attaching importance to peer review? As someone who values scientific, evidence-based analyses but has neither training nor particular expertise in these matters, I take the fact of publication in a peer reviewed journal as an indication that an article has some merit and is worth taking seriously.

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"Peer review has been defined as a process of subjecting an author’s scholarly work, research or ideas to the scrutiny of others who are experts in the same field. It functions to encourage authors to meet the accepted high standards of their discipline and to control the dissemination of research data to ensure that unwarranted claims, unacceptable interpretations or personal views are not published without prior expert review....Within the scientific community, peer review has become an essential component of the academic writing process. It helps ensure that papers published in scientific journals answer meaningful research questions and draw accurate conclusions based on professionally executed experimentation. Submission of low quality manuscripts has become increasingly prevalent, and peer review acts as a filter to prevent this work from reaching the scientific community....Unfortunately, the recent explosion in online only/electronic journals has led to mass publication of a large number of scientific articles with little or no peer review. This poses significant risk to advances in scientific knowledge and its future potential." Jacalyn Kelly et al., "Peer Review in Scientific Publications: Benefits, Critiques, & A Survival Guide", The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (October 24, 2014).

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Indeed, "Scientific peer review ... is a cornerstone of the scientific publication process." Elise Peterson Lu, et al., "Research Methods: How to Perform an Effective Peer Review", Hospital Pediatrics (October 10, 2022).

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What's an example of a possible difference that the absence of peer review might make? There has been prior discussion of a video presentation by Dr. Morgan Micheletti to the May 2023 American Society of Cataract and Refractive Surgery in which he maintains that the Clareon monofocal provides intermediate visual acuity that is noninferior to the Eyhance. Careful viewing of the video reveals, however, that the Clareon was target-corrected to -0.25 D while the Eyhance was targeted to plano. Even with that bias in favor of the Clareon for intermediate vision (because, all else being equal, a slightly more myopic refractive result should produce at least somewhat better intermediate vision), Dr. Micheletti reported that the Eyhance provided 2.5 lines better intermediate visual acuity. Peer review well might compel Dr. Micheletti either to withdraw his claim--because the comparison is apples-to-oranges--or flag the target differential as a limitation of his study.

Dr. Micheletti reported that the Eyhance provided 2.5 lines better intermediate visual acuity.

I think that is 2.5 letters, which might correspond to 0.5 lines or less. I bring up 2.5 letters in one the posts I made waiting for moderation. I am of the opinion that 2.5 letters is significant.

If some document actually says 2.5 lines, then that would clearly be an error.

I confess to all but shrugging off any study put out by the manufacturer of a product. I simply don't believe studies like that aren't set up with parameters that play to the strength of their product and ignore any weakness, or that manufacturers don't throw out any study that doesn't prove what they want. Maybe that's too cynical but that's me. Particularly for things like iols that affect quality of life so much, once they're out in the world, it's time for studies by doctors/organizations with no financial interest in their success.

I can't check now, but I suspect you're correct.

Many of the supplements are manufactured-sponsored. The issues themselves are not. Peer-reviewed journals certainly have their place, but CRSToday is designed as a digest for practicing ophthalmologists so they can quickly and easily access articles on a variety of subjects in their field.

Suppose a cataract surgeon is going to do cataract surgery on someone who also has glaucoma. In the August 2023 issue there is an article titled "Combined Management of Cataracts and Glaucoma." It is an up to date, informative summary of that topic.

The authors are Dr. Mary Qui, Glaucoma specialist at the University of Chicago and Dr Sarwat Salim, Prof of Ophthalmology and Director of the Glaucoma Service at Tufts University School of Medicine. I am sure both have written for peer-reviewed journals but they chose to write in CRSToday to reach the busy practicing cataract surgeon. There are many distinguished ophthalmologists like them who write for that publication, and they do so because they know it serves a need.

As for Dr.Micheletti and the Clareon/Eyhance debate. that will continue to go on. I am quite sure he is aware of all the current peer-reviewed literature and I will leave future discussion of that to him and to other ophthalmologists.

Not every article or presentation need be peer reviewed, especially when an expert is reporting, and giving practice tips based, on their own experience. I also note that the Glaucoma/Cataract article you mention is filled with "may", "can be", and "might". It also has 25 citations to published articles, most, if not all, in journals I recognize as being peer-reviewed. All this has value for the right audience, especially one composed of people already knowledgeable in the field.

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Articles that report on original research are, I believe, in a different category. Here, even when the researchers are eminent, the scientific method relies heavily on peer review for reasons including those given in the quotations I presented in an earlier post.

Trilemma

Just to be sure, the first paragraph on About on the CRSToday page said this:

"Our audience is 10,972 cataract and refractive surgeons. CRST caters to dynamic surgeons looking to advance their practice and techniques. Our how-to format promotes continuing education with topics such as the latest surgical approaches and methods, complications management and avoidance pearls, practice management and business advice, and the latest technological advances. CRST focuses on cutting-edge issues, dives into what is next, and provides a balanced overview of relevant topics."

Thank you for finding my posting useful.

Subscriptions to CRSToday are free. I don't think that's quite the same as open access.

I (and anyone else) can click on any issue of CRSToday and read it for free without a subscription. That seems like open access to me.

"What is OA?

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"Open access (OA) is a set of principles and practices through which research outputs like journal articles are distributed online, free of cost or other access barriers.

"In 'traditional' scholarly publishing, the publisher owns the rights to the articles in their journals. Individuals looking to read these articles may encounter a paywall, requiring them to pay a fee for access. Institutions and libraries (including Lane Library) help provide access to such paywalled research by negotiating with the publishers and paying costly subscription fees. In contrast, open access ensures that the outputs of the research process can be read and built upon by everyone."

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This, and more, on the subject of Open Access can be found at a webpage of Stanford University's Lane Medical Library entitled "Understanding Open Access". If interested in learning more, Google is your friend.

"Subscriptions to CRSToday are free. I don't think that's quite the same as open access."

You brought up "open access." I never said the publication was or was not.

You wrote: "I (and anyone else) can click on any issue of CRSToday and read it for free without a subscription. That seems like open access to me."

I think the "brought up" statement was that you were first to use the phrase "open access" on this thread.

You are correct, Trilemma.

"Subscriptions to CRSToday are free. I don't think that's quite the same as open access."

You do not need a subscription at all (free or paid) to access the articles in CRSToday.

CRSToday is not published as a research journal. It is a publication designed for practicing ophthalmologists, but the articles are often written by academic ophthalmologists who do engage in research.

But I didn't assert that CRSToday was oppen access. And I would have had no occasion to discuss the nature of open access but for @Lynda111 assertion that it is "like open access".

You were the first to use the phrase "open access."