With a central portion 100% dedicated toward distance, the AcrySof IQ ReSTOR +2.5D IOL with ACTIVEFOCUS design moves refractive cataract surgery forward so that it can meet the vision needs of an increasing number of patients. Based on its optical design — an aspheric apodized diffractive surface with a distant-dominant refractive zone at the center — the lens provides a range of functional vision from distance to near and distance vision comparable to a monofocal.¹ These features make it suitable for both presbyopes and non-presbyopes who are motivated to reduce their dependence on eyeglasses and contact lenses.

In my practice, the ReSTOR +2.5D IOL with the ACTIVEFOCUS optical design allows me to meet a fuller spectrum of patients’ vision goals. Having it as a potential choice in addition to the AcrySof IQ ReSTOR +3.0D IOL enables fine-tuning of patient satisfaction.

Matching Patients’ Goals with Solutions

Because of the uncompromised distance vision the lens provides, I’m very comfortable implanting it in the dominant eye of my athletic, active patients, many of whom are golfers, sailors, cyclists, or actors. Previously, I didn’t consider a multifocal in the dominant eye to be an ideal choice due to the potential for glare and halo and/or reduction of contrast sensitivity. What I had been doing instead was placing a monofocal IOL for distance in the dominant eye, and if the patient wanted “social reading” ability, e.g., seeing the cell phone, or eating a meal without glasses, I’d place a multifocal in the non-dominant eye. While this was effective, the patient’s range of vision wasn’t necessarily maximized. Because the ReSTOR +2.5D IOL with the ACTIVEFOCUS design is available, virtually taking away distance vision complaints I typically used to hear, it’s a great choice for the dominant eye, which sets the stage for addressing each patient’s personal priorities more optimally.

I most commonly use ReSTOR +2.5D with the ACTIVEFOCUS design in the dominant eye with the AcrySof IQ ReSTOR +3.0D IOL in the fellow eye. I’ve found that it provides the best range of vision without distance vision complaints. Nuijts and colleagues² showed that, with this approach, there is no compromise of the distance vision defocus curve and patients also achieve good intermediate vision (at around 26 inches) and good reading vision (at 16 to 20 inches) (Figure 1).

I have also implanted ReSTOR +2.5D IOLs with the ACTIVEFOCUS design bilaterally, targeted for plano, with good results. This approach is best when distance vision, or intermediate and distance vision, is the priority for a patient.

I recently implanted bilateral ReSTOR +2.5D IOLs with the ACTIVEFOCUS design for a patient who is an actor but also spends all day using a computer because he’s an engineer. He prefers not to have a refractive difference between his two eyes and he doesn’t mind using reading glasses for closer tasks. He’s very happy with his bilateral ReSTOR +2.5D with ACTIVEFOCUS, and is also a good example of how the lens has improved the intermediate vision that can be achieved with a multifocal. Good intermediate vision is an important consideration for many of today’s cataract surgery patients, an insight drawn from the 2016 ASCRS Clinical Survey.³ Respondents to the survey reported that “on average, presbyopia-correcting IOL patients were less satisfied with intermediate vision than near and distance vision.” For individualized results for patients whose absolute priority is near vision, I recommend bilateral AcrySof IQ ReSTOR +3.0D IOLs.

Patient Selection Remains Important

Early in the era of presbyopia-correcting IOLs, it became clear that a thorough understanding of patients’ personal postoperative vision goals was necessary for success. Both surgeon and patient had to understand what was desired, what was obtainable, and what wasn’t, and they had to consider the patient’s lifestyle. Today, while the evolution in multifocal lens technology, such as the advanced ACTIVEFOCUS lens design, has provided more ways to individually tailor a case and reduce the incidence of post-op visual disturbances, patient education and expectation-setting still matter. It’s something I happen to enjoy. I like discussing with patients what they want, analyzing the situation, and coming up with the best recommendation. By the time I leave the room, the patient and I have decided on the best refractive approach to their cataract surgery. I convey the quick summary to the surgery scheduler, and she goes over further details and dates. The time I spend with each patient has been key to the success of premium IOLs in my practice. Patients always understand what I can and can’t deliver, so it’s rare to have unexpected results, an unhappy patient, or an unexpected need for a secondary intervention.

While I’m discussing with a patient what he or she does for a living and with free time, I review the auto-refraction data, particularly the automated keratometry values. Astigmatism is an important aspect of patient selection, as it always has been with presbyopia-correcting IOLs. It will be a variable much easier to address now that the AcrySof IQ ReSTOR Multifocal Toric IOLs — both +2.5D and +3.0D — have received FDA approval (more on that later). For nearly 100% of my ReSTOR IOL patients, I use the VERION Image Guided System and the LensSx laser (Alcon). Also, I don’t recommend a presbyopia-correcting IOL to patients unless the health of their eye indicates a good prognosis, i.e., no corneal or macular pathology.

With Each Innovation, My Use of ReSTOR IOLs Increases

Since I began using the ReSTOR +2.5D IOL featuring the ACTIVEFOCUS design, the percentage of my patients receiving a ReSTOR lens has increased by 5%. When the recently FDA-approved AcrySof IQ ReSTOR +3.0D Multifocal Toric and the AcrySof IQ ReSTOR +2.5D Multifocal Toric IOLs make their way into my practice, I expect my ReSTOR volume to increase by an additional 10%.

IOLs with the ACTIVEFOCUS design deliver excellent distance vision, minimal to no vision disturbances, and a range of good vision for my patients, a combination of benefits that is ideally suited for the significant number of them who lead active lifestyles.

References

1. AcrySof^® IQ ReSTOR^® +2.5D Multifocal IOL Directions for Use.
2. Nuijts RM, Jonker SM, Kaufer RA, et al. Bilateral implantation of +2.5D multifocal intraocular lens and contralateral implantation of +2.5D and +3.0D multifocal intraocular lenses: Clinical outcomes. J Cataract Refract Surg. 2016;42(2):194-202.
3. American Society of Cataract and Refractive Surgery. ASCRS Clinical Survey. Available at: http://supplements.eyeworld.org/h/i/289602006-ascrs-clinical-survey-2016 . Last accessed: March 30, 2017.

Dr. Serafano practices with Eye Physicians of Long Beach, Calif. He is also an associate clinical professor at the University of Southern California in Los Angeles. Dr. Serafano is a paid consultant to Alcon.