Over the past 17+ years that I have been performing cataract surgery, there has been a significant shift in the technologies available for ophthalmologists and patients. At the start of my surgical career, intraocular lens (IOL) options were slim, leaving many patients without a lens implant that fit their lifestyle needs and offering minimal flexibility in the vision goals they could achieve after cataract surgery.
In 2022, patients continue to live longer, healthier lives—and they want more from their vision. In order to have a competitive practice, surgeons can no longer simply offer all patients monofocal options.
The success of my practice, which I have proudly built over nearly two decades, hinges upon my ability to provide the right premium IOL option for all appropriate patients and customize the choice to their needs.
With the Clareon® Collection, on Alcon’s most advanced IOL biomaterial to-date, I am able to provide my patients excellent vision with exceptional clarity that lasts.*,1-6 Here’s why the surgeons in my practice will be offering Clareon IOLs at all our practice locations.
Trusted Stability, Now Glistening-free†
As an avid user of Alcon’s AcrySof® IQ material, I felt confident trying IOLs in the Clareon Collection. Like AcrySof, the Clareon material has delivered predictable, reliable results. Those results include superior axial and rotational stability*, exceptional vision and predictable refractive outcomes.β, 6-11
However, Clareon goes one step further to address glistenings—providing clarity with among the lowest levels of glistenings and surface haze.**, §,1,2 Clareon has remained glistening-free† in my patients who received implants more than a year ago. This is an exciting improvement on the already dependable platform and also makes the Clareon lens portfolio more appealing to many more surgeons than ever before. 1,2
Premium Options for Today’s Cataract Patient
I like to have a toolbox of versatile, consistent options, and the Clareon Collection—available in Clareon Monofocal IOL, Clareon PanOptix® Trifocal IOL, Clareon PanOptix Toric Trifocal IOL, Clareon Vivity ® Extended Vision IOL, Clareon Vivity Toric Extended Vision IOL and now with Clareon Toric IOL—offers that within a single platform. At every one of our surgical centers, we can now employ the same exact portfolio and be certain that all of the surgeons can find a lens option that suits their surgical style. We can also offer presbyopia mitigating options to a larger variety of patients than ever before.
When determining which lens option to provide to a patient, there are so many individual factors our practice takes into consideration and thoroughly screens for: astigmatism, ocular surface disease, previous refractive surgery, comorbidities, health of the retina, and presence of glaucoma—to name just a few.
We also take hobbies and daily living into account, to get a sense of their personality and then present our patients with the option that we think is best for them. Because we have a consistent lens portfolio at our disposal, we can offer the appropriate lens with even more confidence due to the predictable results we know we can deliver.
For patients who are candidates for a diffractive lens based on a detailed pre-operative workup and don’t like to wear glasses or contacts, I typically recommend PanOptix.12 If the patient finds halos and glares to be particularly bothersome, has comorbidities which do not allow for diffractive lenses, but wants some freedom from glasses, I recommend Vivity. As the surgeon, I feel my patient is looking for my expert advice so I tend to play a very active role in choosing the lens implant with them.
Now, more than ever, I can deliver on the promises I make to my patients, but the key is to set realistic expectations based on the lifestyle goals and the selected IOL. While some IOLs in the Clareon Collection offer reduced spectacle dependence, I do not promise complete freedom from glasses. With this approach I am finding that patients are consistently happy with their results because they know what to expect. They are also happy as the majority of our near requirements have shifted to phone and computer work. The predictable profiles of both PanOptix and Vivity can really help us hit a home run with our surgical results.
Moving to a Single-Material Practice
When first using Clareon, I immediately noticed the more malleable material, and how quickly and easily it unfolded in the eye. The Clareon material, coupled with a new, next-generation delivery system, and the ability to offer six different lenses to my patients, made the choice to offer Clareon in my practice an easy one.13 The delivery system in particular has been a pleasant surprise as it delivers the implant even more freely than before. The newer design leaves more space in the cartridge, and the surgical assistant is even less likely to damage the lens while loading.
The predictable, consistent outcomes with Clareon, and the ability to offer all options on the Toric platform, allows my practice to provide patients an excellent IOL, all while staying on a singular platform. Being able to manage all my IOL inventory with one partner, Alcon, and having consistency in the lenses being implanted all the way from the junior surgeon to multiple centers to multiple surgical counselors streamlines my practice like never before.
The Results Speak for Themselves
My staff and I are impressed with the clarity of the Clareon material. From the optic performance to the patient outcomes and patient satisfaction, the Clareon Collection delivers the level of quality we have come to expect from Alcon IOLs.
As surgeons, it’s our responsibility to push the technological envelope to deliver the best and most customized results to every patient. It can be daunting to try new offerings, but to my colleagues considering the Clareon Collection, I would say trust the lens the way you trusted the AcrySof platform, and you will continue to deliver excellent results to your patients in an even more streamlined fashion. The Clareon Collection has definitely pushed Alcon’s lens quality and predictability to the next level.
*Compared in vitro with enVista† and TECNIS† (n=10 lenses per group, P<0.05).
**Compared to TECNIS, TECNIS OptiBlue, Eternity W-60, Vivinex XY1 and EnVista. Trademarks are the property of their respective owners
†Defined as modified Miyata grade 0, <25mv/mm(2) over 3 years (n=138), and over 9 years (n=20), respectively.
β Both AcrySof and Clareon are designed with STABLEFORCE Haptics
§ Based on in vitro examinations of glistenings, SSNG and surface haze
Important Product Information - Clareon® Family of IOLs
CAUTION: Federal law restricts these devices to sale by or on the order of a physician.
INDICATION: The family of Clareon® intraocular lenses (IOLs) includes the Clareon® Aspheric Hydrophobic Acrylic and Clareon® Aspheric Toric IOLs, the Clareon® PanOptix® Trifocal Hydrophobic IOL, Clareon® PanOptix® Toric, Clareon® Vivity™ Extended Vision Hydrophobic Posterior Chamber IOL and Clareon® Vivity™ Toric IOLs. Each of these IOLs is indicated for visual correction of aphakia in adult patients following cataract surgery. In addition, the Clareon® Toric IOLs are indicated to correct pre-existing corneal astigmatism at the time of cataract surgery. The Clareon® PanOptix® lens mitigates the effects of presbyopia by providing improved intermediate and near visual acuity, while maintaining comparable distance visual acuity with a reduced need for eyeglasses, compared to a monofocal IOL. The Clareon® Vivity™ lens mitigates the effects of presbyopia by providing an extended depth of focus. Compared to an aspheric monofocal IOL, the lens provides improved intermediate and near visual acuity, while maintaining comparable distance visual acuity. All of these IOLs are intended for placement in the capsular bag.
General cautions for all Clareon® IOLs:
Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting any IOL in a patient with any of the conditions described in the Directions for Use that accompany each IOL. Physicians should target emmetropia, and ensure that IOL centration is achieved.
For the Clareon® Aspheric Toric, PanOptix® Toric and Vivity™ Toric IOLs, the lens should not be implanted if the posterior capsule is ruptured, if the zonules are damaged, or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction; if necessary lens repositioning should occur as early as possible prior to lens encapsulation.
For the Clareon® PanOptix® IOL, some visual effects may be expected due to the superposition of focused and unfocused multiple images. These may include some perceptions of halos or starbursts, as well as other visual symptoms. As with other multifocal IOLs, there is a possibility that visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. A reduction in contrast sensitivity as compared to a monofocal IOL may be experienced by some patients and may be more prevalent in low lighting conditions. Therefore, patients implanted with multifocal IOLs should exercise caution when driving at night or in poor visibility conditions. Patients should be advised that unexpected outcomes could lead to continued spectacle dependence or the need for secondary surgical intervention (e.g., intraocular lens replacement or repositioning). As with other multifocal IOLs, patients may need glasses when reading small print or looking at small objects. Posterior capsule opacification (PCO), may significantly affect the vision of patients with multifocal IOLs sooner in its progression than patients with monofocal IOLs.
For the Clareon® Vivity™ IOL, most patients implanted with the Vivity™ IOL are likely to experience significant loss of contrast sensitivity as compared to a monofocal IOL. Therefore, it is essential that prospective patients be fully informed of this risk before giving their consent for implantation of the Clareon® Vivity™ IOL. In addition, patients should be warned that they will need to exercise caution when engaging in activities that require good vision in dimly lit environments, such as driving at night or in poor visibility conditions, especially in the presence of oncoming traffic. It is possible to experience very bothersome visual disturbances, significant enough that the patient could request explant of the IOL. In the parent AcrySof® IQ Vivity™ IOL clinical study, 1% to 2% of AcrySof® IQ Vivity™ IOL patients reported very bothersome starbursts, halos, blurred vision, or dark area visual disturbances; however, no explants were reported.
Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon informing them of possible risks and benefits associated with these IOLs.
ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions.
1. Clareon® IOL Directions for Use.
2. Maxwell A, Suryakumar R. Long-term effectiveness and safety of a three-piece acrylic hydrophobic intraocular lens modified with hydroxyethyl-methacrylate: an open-label, 3-year follow-up study. Clin Ophthalmol. 2018;12:2031-2037 https://pubmed.ncbi.nlm.nih.gov/30349186/.
3. Oshika T, Fujita Y, Inamura M, Miyata K. Mid-term and long-term clinical assessments of a new 1-piece hydrophobic acrylic IOL with hydroxyethyl methacrylate. J Cataract Refract Surg. 2020 May;46(5):682-687. Doi: 10.1097/j.jcrs.0000000000000142. PMID: 32358260.
4. Alcon Data on File, 2020
5. Das KK, Werner L, Collins S, Hong X. In vitro and schematic model eye assessment of glare or positive dysphotopsia-type photic phenomena: Comparison of a new material IOL to other monofocal IOLs. J Cataract Refract Surg. 2019 Feb;45(2):219-227. Doi: 10.1016/j.jcrs.2018.09.017. Epub 2018 Nov 22. PMID: 30471850.
6. Lane, S., Collins, S., Das, K. K., Maass, S., Thatthamla, I., Schatz, H., … & Jain, R. (2019). Evaluation of intraocular lens mechanical stability. Journal of Cataract & Refractive Surgery, 45(4), 501-506.
7. Alcon Data on File, 2017
8. Kramer BA, Hardten DR, Berdahl JP. Rotation Characteristics of Three Toric Monofocal Intraocular Lenses. Clin Ophthalmol. 2020 Dec 16;14:4379-4384. doi: 10.2147/OPTH.S285818. PMID: 33364742; PMCID: PMC7751684.
9. Lee BS, Chang DF. Comparison of the Rotational Stability of Two Toric Intraocular Lenses in 1273 Consecutive Eyes. Ophthalmology. 2018 Sep;125(9):1325-1331. doi: 10.1016/j.ophtha.2018.02.012. Epub 2018 Mar 12. PMID: 29544960.
10. Oshika T, Fujita Y, Hirota A, Inamura M, Inoue Y, Miyata K, Miyoshi T, Nakano S, Nishimura T, Sugita T. Comparison of incidence of repositioning surgery to correct misalignment with three toric intraocular lenses. Eur J Ophthalmol. 2020 Jul;30(4):680-684. doi: 10.1177/1120672119834469. Epub 2019 Mar 6. PMID: 30841757.
11. Clareon® Vivity Directions for Use.
12. Clareon® PanOptix Directions for Use
13. CLAREON MONARCH IV IOL Delivery System – Instructions for use Final
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