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Digital Supplement | Sponsored by Alcon

Synergistic Engineering Considerations Deliver Overall Optical Performance

The AcrySof IQ IOL with ACTIVEFOCUS provides contrast sensitivity comparable to a monofocal and reduces the potential for postoperative visual disturbances.

The multiple design considerations of the AcrySof IQ ReSTOR IOL with ACTIVEFOCUS (Alcon) are additive in delivering overall optical performance. The lens has been specifically engineered to provide quality vision across near, intermediate, and distance while also allowing surgeons flexibility to tailor the surgical plan to the visual needs of the patient. Maintaining the final vision is then facilitated by properties that confer greater mechanical stability of the IOL placement to decrease the potential for axial rotation—and a certain margin of error should slight decentration occur.

The result of these considerations for design is that they provide the best conditions for ensuring patients are happy with the final visual result. Patients opting for premium lenses may be more demanding of final vision compared with monofocal patients, and so reducing the potential for visual compromises may go a long way to meeting those expectations. Inevitably, this includes reducing the incidence of halo, glare, and other visual disturbances that may lead to uncomfortable vision.

Quality Distance Vision and a Full Range of Vision

The ACTIVEFOCUS design with 7-step diffractive stops is intended to provide greater energy distribution for distance vision, and more energy distribution overall, thus ensuring uncompromised distance vision with a full range of vision (Figure 1).1-3 Yet, achieving quality distance acuity does not mean having to sacrifice near vision, as the AcrySof IQ IOL with ACTIVEFOCUS provides for closer near acuity compared with other presbyopia-correcting IOL technologies (Figure 2).4,6,7

Figure 1. Overview of design profiles and implications of two presbyopia-correcting IOL platform technologies. Note: Optical profile of the ReSTOR +2.5 D model SV25T0 is based on the design profile. Surface profile of the TECNIS Symfony 28.0 D IOL (Johnson & Johnson Vision) measured using Bruker Contour white light interferometer on the posterior surface and the diffraction efficiency calculated.

Figure 2. Peak near performance with on-market presbyopia-correcting IOLs.

Important Product Information

Low Incidence of Visual Disturbances

The unique distance-dominant ACTIVEFOCUS optical design was added to the AcrySof IQ platform using the same spherical aberration correction factor in monofocal models and, therefore, provides comparable contrast sensitivity (Figure 3).9 In addition, the aspheric construction improves image quality for distance vision under mesopic conditions.2

Figure 3. Binocular mesopic contrast sensitivity with the AcrySof IQ ReSTOR +2.5 D IOL with ACTIVEFOCUS versus AcrySof IQ ReSTOR monofocal IOL.

These features mean that patients are less likely to experience reduced compromise in the quality of the final vision. Importantly, though, the AcrySof IQ is specifically designed to minimize the potential for problematic visual disturbances, such as halo and glare (Figure 4).10

Figure 4. In simulations of the effect of an oncoming headlight on quality of vision, the AcrySof IQ IOL exhibited less potential to induce troublesome haloing compared with other IOL platforms.

Conclusion

IOL options that are clinically proven to reduce visual disturbances address an issue that has historically been a point of consternation with presbyopia-correcting IOLs. Visual disturbances due to light diffracting through multiple optical zones on multifocal lens designs are rightly considered a safety issue, as they may affect patients’ ability to function with their postoperative vision—for example, interfering with nighttime vision.

Above and beyond the potential to avoid positive dysphotopsias after cataract surgery, modern IOL designs are also engineered to provide the overall quality of vision that patients expect. The combination of features on the AcrySof IQ ReSTOR IOL with ACTIVEFOCUS helps deliver overall optical performance to help patients achieve postoperative vision goals and wind up happy with the result.

AcrySof, ACTIVEFOCUS, and ReSTOR are trademarks of Novartis. © Novartis 2018. All other brand/product names are the trademarks of their respective owners.

1. Alcon Data on File (April 11, 2016).

2. Vega F, Alba-Bueno F, Millán MS, Varon C, Gil MA, Buil JA. Halo and through-focus performance of four diffractive multifocal intraocular lenses. Invest Ophthalmol Vis Sci. 2015;56(6):3967-3975 (study conducted with corneal model eye with 0.28μ spherical aberration).

3. Henderson B, Solomon K, Masket S, et al. A survey of potential and previous cataract-surgery patients: what the ophthalmologist should know. Clin Ophthalmol. 2014;8:1595-1602.

4. AcrySof IQ ReSTOR +2.5 D IOL Directions for Use.

5. Alcon Data on File (Oct 17, 2016).

6. TECNIS Symfony Extended Range of Vision IOL Directions for Use.

7. AcrySof IQ ReSTOR +3.0 D IOL Directions for Use.

8. Nuijts RM, Jonker SM, Kaufer RA, et al. Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: clinical outcomes. J Cataract Refract Surg. 2016;42(2):194-202.

9. Alcon Data on File (Aug 7, 2013).

10. Alcon Data on File (May 17, 2016).

author
Brandon D. Ayres, MD
  • Surgeon in the Cornea Service, Wills Eye Hospital, Philadelphia
  • bayres@willseye.org
  • Financial disclosure: Consultant (Alcon)
author
Bonnie An Henderson, MD
  • Partner in Ophthalmic Consultants of Boston and a clinical professor at Tufts University School of Medicine, Boston
  • bahenderson@eyeboston.com
  • Financial disclosure: Consultant (Alcon)
author
James A. Katz, MD
  • Director of Golf Laser Vision and a partner at The Midwest Center for Sight, Chicago, Illinois
  • jkatz@tmcfs.com
  • Financial disclosure: Consultant (Alcon)

AcrySof® IQ ReSTOR® Family of Multifocal IOLs Important Product Information

CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician.

INDICATIONS: The AcrySof® IQ ReSTOR® Posterior Chamber Intraocular Multifocal IOLs include AcrySof® IQ ReSTOR® and AcrySof® IQ ReSTOR® Toric and are intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. In addition, the AcrySof® IQ ReSTOR® Toric IOL is intended to correct pre-existing astigmatism. The lenses are intended to be placed in the capsular bag.

WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling for each IOL. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery.

The ReSTOR Toric IOL 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.

Some patients may experience visual disturbances and/or discomfort due to multifocality, especially under dim light conditions. A reduction in contrast sensitivity may occur in low light conditions. Visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. Spectacle independence rates vary; some patients may need glasses when reading small print or looking at small objects.

Posterior capsule opacification (PCO), when present, may develop earlier into clinically significant PCO with multifocal IOLs. 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 the AcrySof® IQ ReSTOR® IOLs.

Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions.

ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions.