An interview with Richard Tipperman, MD, a cataract and refractive surgeon with Wills Eye Hospital in Philadelphia, PA

QUENTIN B. ALLEN, MD: The AcrySof^® IQ PanOptix^® Trifocal Intraocular Lens incorporates new proprietary technology that sets it apart. Dr. Tipperman, please tell us about ENLIGHTEN^® Optical Technology.

DR. TIPPERMAN: The ENLIGHTEN^® Optical Technology is one of the features that makes this lens so exciting. When you look at focus-defocus curves for traditional multifocal IOLs, you see they all have some degree of what I call a camel hump—two peaks where range of vision was good, but one trough where the range of vision isn’t nearly as good—and that often leads to dissatisfaction.

When you look at the focus-defocus curve for the PanOptix^® Trifocal lens, you see how flat it is across the 20/20^*†1 line for all ranges of vision. That leads to very happy patients, very happy staff, and very happy doctors.

DR. ALLEN: In your experience, how does the PanOptix^® Trifocal with ENLIGHTEN^® Technology differ from traditional trifocals?

DR. TIPPERMAN: Traditional trifocal lenses have a near point of about 40 cm, a midrange point of about 80 cm, and then distance vision. Studies have shown that the 80 cm focal point is not a comfortable intermediate distance for most patients.^2,3 Alcon’s engineers based ENLIGHTEN^® Technology on the rules of diffractive optics. They created a fourth focal point at 120 cm, and then redirected the new first-order intermediate focal point’s light energy to distance (Figure 1).

DR. ALLEN: What is the effect of ENLIGHTEN^® Technology on a patient’s range of vision compared with older technologies?

DR. TIPPERMAN: With prior lens technologies, the focus-defocus curve can be bimodal. There can be good quality vision at distance and good quality vision at intermediate or near, but rarely at all three distances. Rarely do we see the focus-defocus curve flat at a 20/20 or 20/25 level across all ranges of vision. With ENLIGHTEN^® Technology, because of how the incoming light energy is handled, distance vision is excellent from about +0.50D through plano and all the way out to a good reading vision with a focal point of 3.00D (Figure 2).

DR. ALLEN: How has this technology influenced your approach to presbyopia-correcting IOLs? Is there any characteristic of the PanOptix^® lens that is of particular interest to you as a surgeon?

DR. TIPPERMAN: Now that I’ve been using the PanOptix^® lens and have seen the results, I no longer have to think about good quality vision for distance, intermediate, and near, because the ENLIGHTEN^® Technology gives patients a normal range of vision. That’s one of the reasons why this technology is so easy to use clinically.

I’d be remiss if I didn’t mention that the sweet spot of the lens is also much larger as well; the focus-defocus curve in other technologies drops off for many patients as they become somewhat hyperopic postoperatively.

The focus-defocus curve of the PanOptix^® Trifocal stays at the 20/20 level even in the early hyperopic range of about +0.50D. That is a much larger sweet spot, offering much greater tolerances for the surgeon.

DR. ALLEN: That’s a great overview of the engineering and technology, and it helps explain the high levels of patient satisfaction with the PanOptix^® Trifocal IOL. In the FDA study, 99.2% of patients reported they would have the same lens implanted again.¹

It’s also important to understand how the focus-defocus curve for the PanOptix^® Trifocal IOL allows for a larger sweet spot at distance and great visual acuity through the intermediate range.

How do you explain the nuances of the ENLIGHTEN^® Technology to patients and what they can expect?

DR. TIPPERMAN: Over time, my discussions with patients preparing for cataract surgery have changed as technologies have improved. When discussing the PanOptix^® Trifocal, I can tell patients, “You’re going to have a much more natural range of vision and much more visual function. Yes, you might wear eyeglasses from time to time, but compared with your other option, a single-focus monofocal lens, you’re going to function so much better.”

DR. ALLEN: That’s a great reminder that not all patients would be satisfied with the loss of range of vision with a monofocal IOL. Many come to our practices specifically hoping to reduce their need for reading glasses at the time of cataract surgery. In my experience, these are some of my happiest patients, and the high-quality range of vision with the PanOptix IOL is able to meet many patients’ expectations.

Some surgeons and practices still aren’t using the PanOptix^® Trifocal IOL. What would you say to encourage them to start offering it to their patients?

DR. TIPPERMAN: As eye surgeons, we’re always trying to give patients the best possible visual function and quality of vision. To leave someone presbyopic with a monofocal lens can hamper a patient’s lifestyle. Giving older patients good range of vision that enables them to function well uncorrected most of the time significantly improves their day-to-day activities.

I also recognize that some surgeons tried earlier-generation technologies and weren’t satisfied with the clinical results, or they weren’t confident with the results that they could deliver for their patients. Surgeons have to try new technologies for themselves to see how they work in their hands and for their patients. They can’t necessarily act on what they hear from other people.

But, I think as surgeons see the experiences that their peers are having with the PanOptix^® Trifocal lens, as they see the excellent clinical results it delivers, they’ll become more comfortable getting back in the game and using this technology.

DR. ALLEN: What makes the PanOptix^® lens an excellent choice for surgeons and their staff and for patients, as well?

DR. TIPPERMAN: Surgeons and staff want happy patients; they make your day nicer and are easier to take care of. The PanOptix^® lens delivers happy patients. It’s remarkable when you walk into the lane on the first post-op day after implanting a PanOptix^® Trifocal lens and your patient greets you with a big smile. Patients often tell me, “This is great. I can really see at different distances. I’m really pleased.” That makes the staff happy and that makes providing care and education so much simpler.

As you become more comfortable with this technology, your pre-op discussions with patients become simpler because you’re confident in what you can deliver with the PanOptix^® Trifocal. You can sit across from a patient and say, “This is going to give you better functional vision at all ranges than you’re going to get with a monofocal lens.” It just makes everyone’s life easier.

DR. ALLEN: If you could describe PanOptix^® in one word, how would you describe it?

DR. TIPPERMAN: It’s remarkable technology. Having lived through all of the different generations of presbyopia-correcting lenses, I now have an implant that can give great clinical results for patients who are good candidates. It’s just a remarkable technology to have. •

REFERENCES

1. AcrySof^® IQ PanOptix^® Directions for Use.
2. Carson D, Xu Z, Alexander E, Choi M, Zhao Z, Hong X. Optical bench performance of 3 trifocal intraocular lenses. J Cataract Refract Surg. 2016;42(9):1361-1367.
3. Kohnen T, Herzog M, Hemkeppler E, et al. Visual Performance of a Quadrifocal (Trifocal) Intraocular Lens Following Removal of the Crystalline Lens. Am J Ophthalmol. 2017;184:52-62.
4. Alcon Data on File.
5. Alcon Data on File.

^*Based on mean value of binocular defocus curve at near, intermediate and distance at 6 months (n=127)

^†Snellen VA was converted from logMAR VA. A Snellen notation of 20/20-2 or better indicates a logMAR VA of 0.04 or better, which means 3 or more of the ETDRS chart letters in the line were identified correctly.