Best non-multifocal lens? Effect of eye drops on the IOL surface?

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For multifocal and EDOF I see couple of clear cream of the crop lenses but what about non-multifocal lenses?

Which model/brand is highly reputable? Non glistening/does not become milky/opaque after few years, non-silicon based, hydrophobic, helps against PCO if possible, thin edge, UV filter cancelling, blue light filter, eye friendly haptics etc etc?

Basically which lens has a good track record and of superior long term quality!

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  • Posted

    With each generation of lens improving on the prior generation, the latest is often the best.

    J&J just launched a new MONO-FOCAL in Europe the Tecnis Eyhance IOL. I expect this will be the best one now, as it builds on a solid foundation of Tecnis monofocals and improves on it. Only launched in Europe, not the US.

    It is clearly described as a mono-focal not a edof,  yet it "extends" the death of focus to provide good intermediate and distance vision with less artificants than edofs.  I first read about this lens in the transcripts to the Q1 2019 Alcon earnings call (where Alcon is very upbeat on PanOptix getting approval in the US soon -- one analysts mentions a new J&J intermediate lens in Europe that's at a lower price point).
    

    You can find some articles by searching for Tecnis Eyhance. Here's one.

    Delivering Intermediate Vision: The New TECNIS Eyhance Monofocal IOL

    Also search Newer generation IOL platforms designed for high-quality visual performance after cataract surgery

    for discussion of the Tecnis Eyhance. This article also confirms all three leading tri-focals (PanOptix, AT LISA, and FineVIsion) perform well, with the PanOptix performing a little better.

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    • Posted

      Wow The Eyhance looks like a great choice for a monofocal IOL. Why does the US take so long to approve these lenses?! Rhetorical question.

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    • Posted

      Kind of untested, not enough data!

      New Tecnis Eyhance Offers EDOF Functionality

      “It is important to understand that this is not a monofocal but falls more closely into the category of an EDOF IOL without any of the possible compromises the latter may cause in regard to night time visual disturbance such as haloes and starbursts,” said Dr Dean Corbett from Auckland Eye in New Zealand.

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    • Posted

      You can download a detailed PDF from the first link I provided (Delivering Intermediate Vision: The New TECNIS Eyhance Monofocal IOL).

      I think Dr. Corbett from NZ is incorrect. The Eyhance clearly a mono-focal. It is a mono-focal that delivers good intermediate vision. All the articles are very clear the Eyhance is not an edof (Tecnis of course already has the Symfony EDOF), and the Eyhance is at a lower price point (I got this info from Alcon Q1 Quarterly Earnings call transcript - where a lot of the discussion is about PanOptix, but an analyst asks about a new J&J intermediate focus lens at a lower price point).

      The releases are articles seem to be extremely clear that the Eyhance is a next generation mono-focal (and not a cheaper version of a EDOF).

      Definately limited data, as testing as been based on clinical trials in Europe. But if is it a mono-focal, and is based on the established Tecnis mono-focal platform, I think risk is not as big as it is an improvement on something that has been well established. I would ask more questions and see what this is about.

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    • Posted

      If you set aside the Tecnis Eyhance (which is very new, and looks very promising so it is something I would look into if I wanted a monofocal in Europe), then of the current crop of mono-focals, I'm not sure there is a best one.

      I think more surgeons prefer the Alcon AcrySof because it unfolds slowly and has extremely good rotational stability, so it is easy to implant very precisely to get the best results. But there are also many who prefer the J&J Tecnis due to no glistenings. (note Alcon did change the manufacturing process to reduce the likelihood of glistenings, but some (such as Deb03) still have problems with glistenings).

      You don't get much analysis of how Zeiss monofocals might compare to Alcon or J&J because Zeiss has never sought FDA approval in the US, so globally, Zeiss has a smaller market share.

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    • Posted

      I have the Alcon AcrySof (the injectable unfolding one)and suffer with positive dysphotopsia,I find it is horrendously reflective and having trawled the internet many are in the same boat with the same side effects,some have been lucky and they have diminished with time but many have not and have had had to have an exchange.I have been told to wait it out and see as the only alternative is to just live with it.Be wary of this one as it is used widely as it may save you from PCO but does not have a good record for edge glare,eye flicker etc

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  • Posted

    I would not recommend the lens I have (Alcon Acrysof IQ SN60WF) because of its high refractive index and glistenings. From my research, Tecnis seems like a good choice. From my research also, it seems the square-edge design is the bigger factor in preventing PCO compared to the material. There is no proof that the blue-light filter helps. It was a nice to have for me, but I would not make it the deciding factor. Wear sunglasses. I would add to your list IOLs which are less prone to cause positive and negative dysphotopsia. Keep in mind, younger eyes dilate more.

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  • Posted

    Intraocular lens design was found to be the key determining factor in the rate of posterior capsular opacification (PCO) development in a large series of microincision cataract surgery (MICS) lenses, according to a study.

    At the meeting of the French Society of Ophthalmology, Gilles Lesieur MD presented the analysis of a large series of 6,500 lenses with up to eight years’ follow-up.

    “Although we know that PCO is multifactorial and that surgical technique, IOL biomaterial and patient characteristics may all play a role, the key factors in its development seem to be the presence of a square-edged design and the sharpness of the posterior edge of the optic,” he said.

    Dr Lesieur’s retrospective analysis included seven different MICS lens types: CT Asphina (Zeiss), Micro AY, MicroSlim and Micropure (PhysIOL), Akreos MICS (Bausch and Lomb), Incise (Bausch and Lomb) and Synthesis (Cutting Edge).

    The Akreos MICS was found to have the highest rate of Nd: YAG laser capsulotomy over the eight-year follow-up period. “This is perhaps due to the design of the lens, with excessive polishing of the optic edges presenting less of a barrier to lens epithelial cell migration,” he said.

    The MicroSlim, with its uninterrupted square-edge optic, recorded the lowest rate of PCO, noted Dr Lesieur, while the CT Asphina’s plate haptic design with a square edge only delayed PCO for the first three years with Nd:Yag rates increasing thereafter.

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    • Posted

      Six Keys to Preventing PCO

      Six Critical Factors

      Dr. Apple has identified six factors that are key to preventing or retarding PCO.

      Three surgical factors:

      Hydrodissection-enhanced cortical cleanup
      A continuous curvilinear capsulorhexis diameter slightly smaller than that of the IOL optic
      “In-the-bag” fixation of the posterior chamber IOL
      

      Three IOL-related factors:

      The geometry of IOLs: a square, truncated edge
      The biocompatibility of IOL biomaterials (to curtail stimulation of cellular proliferation)
      Maximal IOL optic-posterior capsule contact
      
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    • Posted

      Cut and paste did not work good, second attempt-

      Six Critical Factors

      Dr. Apple has identified six factors that are key to preventing or retarding PCO.

      Three surgical factors:

      1. Hydrodissection-enhanced cortical cleanup
      2. A continuous curvilinear capsulorhexis diameter slightly smaller than that of the IOL optic
      3. “In-the-bag” fixation of the posterior chamber IOL

      Three IOL-related factors:

      1. The geometry of IOLs: a square, truncated edge
      2. The biocompatibility of IOL biomaterials (to curtail stimulation of cellular proliferation)
      3. Maximal IOL optic-posterior capsule contact

      Dr. Apple singled out hydrodissection-enhanced cortical cleanup as the most important of these factors. “In my opinion, that’s 85 percent of it,” noted Dr. Apple. “If you clean out the cells really well, there won’t be any of them left in the capsular bag that can lead to a secondary cataract. You can even have a fairly mediocre lens and still not have PCO if you succeed with good cortical cleanup.”

      Some investigators have evaluated the intraocular infusion of pharmacologic agents (such as preservative-free lidocaine 1 percent) to improve cortical cleanup, although long-term studies of such agents have not been performed. One new development involves the PerfectCapsule device (see PerfectCapsule below).

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