A logical approach to selecting presbyopia-correcting implants

Without doubt, extended depth of focus (EDOF) lenses have actually aroused a heightened interest in presbyopia-correcting lenses for eye surgeons and also patients alike. These implants provide an elongated focal range as opposed to two distinctive focal points as in a multifocal lens. Although optically it utilizes a distinctive mechanism, functionally the Tecnis Symfony works similar to a low add multifocal in giving individuals distance as well as intermediate vision for all practical purposes.
But like any type of lens that extends beyond a solitary focal point, the EDOF Symfony does have its limitations. Despite having an excellent emmetropic outcome, a couple of people whine about “spiderweb” glare, particularly while driving at night. These problems become much more usual when there is residual refractive error. These implants are indeed a lot more forgiving of residual refractive error than traditional high add multifocals, but have actually been found unsuitable for doing mini-monovision with them as a result of these unwanted visual phenomena.

About 60% of cataract patients select presbyopia-correcting lenses, as well as right here’s an approach that has actually been found to be extremely rational based on data from a number of researches carried out on patient satisfaction.
Initially, let’s think that let’s only speak about people that are good prospects for a multifocal or EDOF lens. They have healthy maculas, the most sensitive part of the retina, manageable dry eye and fairly aberration-free corneas.
For individuals that prefer distance and intermediate (however not near), if they have low astigmatism, the Symfony lens is an excellent option. It has high refractive accuracy as well as only rare concerns with unwanted visual sensations. Various other reasonable selections for this patient are reciprocal ReSTORActiveFocus 2.5 lenses or Crystalens, targeting emmetropia (This  term used to describe a person’s vision when absolutely no refractive error or de-focus exists) with all of the above.
If a patient has astigmatism greater than 0.5 D and also needs distance and intermediate vision, the Symfony toric (as well as other Tecnismonofocal and also multifocal lenses) does not have rotational stability to be completely confident of it. Rather, select a ReSTORActiveFocus 2.5 toric or Trulign (the toric variation of Crystalens) for both eyes, again targeting emmetropia. The ActiveFocus lens produces the lowest problems of glare and also halos of any type of multifocal used, and also has outstanding rotational stability in its toric form.
For patients who desire distance, intermediate and also near, targeting a mini-monovision with an EDOF Symfony lens is not advised. Too many of these patients do not endure the spiderwebs in the non-dominant, near eye. Rather, these people will certainly succeed with a ReSTORActiveFocus 2.5 in the leading and a +3.0 ReSTOR in the non-dominant eye. (With reduced astigmatism, it likewise makes good sense to do this with a Tecnis multifocal 2.5/ 3.25 also, once again for patients with low astigmatism).
An additional approach for patients desiring distance, intermediate as well as near vision is to do mini-monovision with either the ReSTORActiveFocus 2.5 (targeting plano and also -0.5 for the dominant and also non-dominant eyes, specifically) or the Crystalens (targeting plano and -0.7 D). When greater than 0.5 D of astigmatism exists, the toric variations of each these lenses offer excellent rotational stability, with the Trulign having the best rotational stability of any presbyopia-correcting lens, according to FDA research study data.
It has actually been seen that patient satisfaction increases by utilizing software programs that motivate every postop patient to report his/her perceptions in an organized way. A recent research carried out checked out the mix of a ReSTORActiveFocus 2.5 blended with a ReSTOR 3.0 in the leading and non-dominant eyes. Contrasting these patients to similar eyes that obtained bilateral 3.0 add ReSTOR lenses, some essential differences were found: Spectacle independence is virtually identical, other than that patients with a 2.5/3.0 mix have considerably better computer vision than 3.0/3.0. Also, glare and also halo issues were considerably much less prevalent in patients implanted with the 2.5/3.0 mix. It is suspected this is due to the fact that the ActiveFocus lens has a distance-focused central optic, generating comparable low contrast vision to a mono-focal implant.
Data is also being collected on patients with mini-monovision using the ActiveFocus system in both eyes. This strategy also seems promising currently, as spectacle independence is preserved without substantially producing glare and halos.
Simply a few years back, it was impractical to hope that we might provide people distance, intermediate and also near vision with multifocal lenses. Both EDOF and low add multifocal lenses now hold promise for patients to have natural, uncompromised vision after cataract surgical procedure. The new lenses have actually absolutely converted doctors committed to practically exclusively using fitting implants, to those that are fully comfy advising multifocal and EDOF technology as a front runner to well-selected patients.

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