Viewpoint

Big news on the premium IOL front

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

In March of last year, a singular, if not truly unique, meeting took place between two entities whose acronyms are near and dear: the AAO and the FDA. The purpose: to discuss premium lenses. More specifically, what constitutes the specifications of the new classification called extended depth of focus (EDOF). What a great idea. Let’s revisit why uniformity is an even better idea.

Memory Lane and a pothole or two

Years ago the forerunners of today’s premium lens implants arrived in the form of multifocal and astigmatic IOLs. Later came accommodating IOLS, and then a whole wave of newer multifocal lenses.

Until now, especially with the presbyopic IOLs, there’s been a dilemma or two. The accommodating implants have been great, except when they don’t accommodate and the patient is upset because he sees only monofocally and he has paid to see more. The multifocal implants are great, except when the patient has such horrible glare/haze/waxy vision that he is begging for them to be removed, and there’s a little PCO, which might be the problem. But if you perform YAG capsulotomy and symptoms remain, then you have a new explantation challenge.

There are many premium implants, and potentially more in the works trying to get to market — including the EDOF implant. These IOLs purport to give an expanded range of focus without significantly affecting distance vision, with a side effect profile similar to monofocal IOLs. At least two companies are working with different mechanisms to bring us just such lenses.

A good meeting

But until recently, the FDA didn’t have consistent measures with which to decide what implants got in and which ones were kept out. So the AAO said, ‘let’s meet’ to the FDA and they created a task force to sort out a mechanism by which everyone would know the rules and how they’d be applied going forward. (See “Agency, AAO, are quantifying extended depth of focus,” page 11 and “Redefining the meaning of premium,” page 62.) If the EDOF concept works, it could revolutionize the way we think about premium lenses. For those of us who insert blended and monovision implants already, EDOF could take us to a new level.

So stay tuned, you’ll probably be hearing more about this in the near future. (With luck, the next meeting will be about multifocals, at which the two will rule they be called bifocals, because if you look at the defocus curves, that’s what these lenses are.)

On an unrelated note, I’m happy to report Signet Research has found through a study that Ophthalmology Management is the publication that you say changes how you practice and care for your patients — more than any other. Many thanks. OM