What are my options Doc?

Author: Hamza Shah OD, MS

Interpreting the data:

LensX corrects for 1.00D against-the-rule (ATR) astigmatism and 1.50D with-the-rule (WTR) astigmatism, allowing patients to tolerate some residual WTR astigmatism. There’s also a consideration that leaving a bit of WTR astigmatism may be beneficial, as patients tend to shift toward ATR astigmatism with age due to changes in the cornea and sclera.

Cost: Toric implants are approximately $1,500 more per eye than standard cataract extraction with LensX. Multifocal lenses are around $2,100 more per eye.

It’s crucial to thoroughly evaluate the patient's ocular health. If they have other conditions that may limit their visual potential, this will greatly influence which lens options are appropriate and which ones should be avoided. These factors are discussed in more detail below.

 
DOI: 10.1038/s41433-024-03045-w

Types of Intraocular Lenses (IOLs)

Monofocal IOL

Provides the best vision at one focal point, which can be set for distance, intermediate, or near vision.

Toric IOL

Corrects vision in two meridians, addressing astigmatism by correcting both the spherical and cylindrical components.

Enhanced Monofocal IOL (e.g. Eyhance)

Primarily provides good distance vision with some intermediate vision.

  • More forgiving than multifocal or EDOF lenses for patients with ocular conditions that may limit vision.

Extended Depth of Focus (EDOF) IOL (e.g. Symfony, Vivity)

Features a stretched focal zone to provide both distance and some intermediate vision.

  • Has a continuous range of focus with fewer visual disturbances (dysphotopsia) than multifocal lenses.

Multifocal IOL

Includes multiple corrective zones, similar to multifocal contact lenses, offering clear vision at distance, intermediate, and near focal points.

Light Adjustable Lens (LAL)

A monofocal IOL that can be adjusted post-surgery using UV light to fine-tune the power.

  • Provides approximately 0.75D of depth of focus.
  • LAL+ version offers slightly more depth of focus.

Apthera IOL

A non-toric EDOF lens that can mask up to 1.50D of astigmatism. The pinhole effect enhances depth of focus, with patients set at -0.75 achieving J2 vision in FDA trials.

  • Can offers about 2.00D of depth of focus.
  • Ideal for post-refractive surgery patients or those with mild corneal ectasia.
  • Requires patients to dilate up to 7mm, and proper lens centration is critical.

Accommodative IOL (Crystalens)

Utilizes the natural movement of the ciliary muscles to change focus.

  • Scarring may reduce its accommodative effect over time.
  • Some patients experience vaulting (z-syndrome) after capsular fibrosis occurs.