Cataract surgery is the most frequently performed surgery in the United States, with close to 4 million procedures in 2018. Due to the aging of our population, this growth is anticipated to increase roughly 16 percent by 2024 in the US. The fastest area of growth has been in the use of presbyopia-correcting IOLs, which is expected to increase by 60 percent by 2024.
Presbyopia is a universal condition that affects most individuals, with symptoms typically beginning as people enter their 40s with progressive changes worsening until an individual’s 60s. It involves the age-related loss of ability to focus on objects up close including such common tasks as cell phone usage, computers, books, and menus. Eyeglasses, contact lenses, and some intraocular lenses can correct presbyopia.
Presbyopia Correcting IOLs
Patients who require cataract surgery for improvement in their vision and ability to improve their activities of daily living have two broad types of intraocular lenses, monofocal or multifocal IOL, to choose from when planning their cataract surgery. The chief goal of multifocal IOL implants is to be able to help correct a patient’s presbyopia, allowing restoration of vision at all distances and reduce or eliminate the need for eyeglasses or contact lenses after surgery.
To understand how these implants work, with both their advantages and drawbacks, it is first useful to realize that visual tasks fall into three main working distances: near (books, cell phone, prices in stores); intermediate (computer distance, reading music); and distance (television, driving). All modern presbyopia-correcting implants seek to regain the ability to see well at all of these three distances, although each of the implants has their own strengths and weaknesses at these distances. They also have the same potential side effects of visual disturbances such as glare, rings and starburst around light, and reduced contrast sensitivity.
PanOptix, which is manufactured by Alcon Surgical, is the newest multifocal IOL implant to be introduced in the United States. This was approved by the FDA on August 27, 2019 and is currently available for usage. Prior to its introduction to the US, PanOptix was used in over 70 countries worldwide. The chief advantage of PanOptix over other multifocal IOLs from reports in Europe appears to be improved near vision while still retaining intermediate and distance acuity. The chief disadvantage of this lens is its slightly higher cost than competitors as well as possibly having more glare issues with night vision. This implant is available in toric and non-toric versions depending upon the amount of astigmatism correction that is required.
Symfony extended focus IOLs (J & J Vision) are available both toric and non-toric and are currently the most commonly used presbyopia correcting implant in the US. There have been many years of experience with this implant with excellent visual results. Although experience in the United States is still limited, it appears that near vision in the Symfony may be not as good as with PanOptix, although the beneficial tradeoff is that distance vision and reduction in glare may be better with Symfony.
Older presbyopia correcting implants that are used less now include the Alcon ReSTOR and Crystalens by Bausch & Lomb. The dramatic rise in the frequency of cataract surgery due to the aging of the population as well as the demand for implants that can correct presbyopia and eliminate the need for glasses gives industry a strong incentive to develop new and improved implants to meet this need. It will be exciting to watch as new implants are released to improve our vision in the future.