Surgeons say the RayOne EMV is a good choice for modified monovision.

As the portfolio of intraocular lenses (IOLs) expands, cataract surgeons have more options than ever before to customize a treatment plan that meets their patients’ needs. The introduction of the RayOne EMV IOL from Rayner provides a new option for a modified monovision (or “mini-monovision”) approach.

The new lens was developed in collaboration with the world-renowned Australian surgeon Prof. Graham Barrett, AM, MBBch, FRANZCO, with the goal of designing a custom IOL specifically for modified monovision. The lens uses positive spherical aberration to extend the depth of focus, targeting bilateral emmetropia or monovision without some of the issues that tend to arise with diffractive lenses. As a result, there is a smoother blended transition from distance to intermediate vision, and from intermediate to near vision.

According to Rayner, the positive spherical aberration of the lens complements the natural spherical aberration of the human cornea, which results in the increased depth of focus. The RayOne EMV is available in powers from 10.00 D to 30.00 D, in 0.50 D increments, with the entire power range available in a preloaded injector.

FULLER RANGE OF VISION

Phillips Kirk Labor, MD, FACS, FICS, ABES, president and owner of Eye Consultants of Texas and LoneStar Ambulatory Surgery Center, says that he had been searching for a lens to better support modified monovision with better near acuity. He says that this is often a patient’s preferred choice for presbyopia management; however, previous lens choices had accompanying side effects.

“The RayOne EMV lens has provided a fuller range of vision for those patients who’ve made mini-monovision or even true monovision their choice for presbyopia correction,” says Dr. Labor. “The EMV tends not to create dysphotopsias that often accompany other extended depth of focus (EDOF) or multifocal lenses.”

Dr. Labor suggests this lens for any patient who is interested in presbyopia correction. The mid-tier pricing of this lens provides an option for presbyopia correction at a more affordable price point than premium IOLs designed for this purpose, though any patient who does prolonged near work might still require a low-add reader, he notes.

“In my practice, our initial outcomes analysis revealed patients who were capable of binocular uncorrected near acuities of 20/30, which is good enough to read newspaper print,” he says. “So patients have been quite pleased with their results.”

Karl Stonecipher, MD, clinical professor of ophthalmology at the University of North Carolina and Tulane University and medical director of Physicians Protocol and Laser Defined Vision in Greensboro, North Carolina, agrees that a patient who desires high-quality distance and intermediate vision and can accept the possibility of needing a low-add reader would make a good candidate for the RayOne EMV lens.

“It is the positive spherical aberration at the center of its optic that makes this lens a unique solution,” Dr. Stonecipher explains. “Coupled with a blended edge region, the result is good contrast sensitivity and improved visual acuity. My patients have achieved an increased range of vision and aren’t coming back for corrections.”

A CATEGORY OF ITS OWN

While premium IOLs have continued to expand surgeons’ options, allowing for a more customized solution, the financial reality is that the cost of premium lenses places them out of reach for many patients. That’s another reason why Karolinne Rocha, MD, PhD, a cataract, cornea, and refractive surgeon at the Medical University of South Carolina, says she is excited about the RayOne EMV lens. She calls it a “new category,” that provides a mid-level price point for patients.

“We can now offer patients a premium option that might not have been available to them before,” she says. “It continues to expand our lens portfolio in many ways, including from a financial standpoint.”

Dr. Rocha explains that the high Abbe value of this lens (56) minimizes chromatic aberration and allows for high-quality vision.

“This is a new generation of lenses that we might call premium monovision,” she says. “The distance vision is fantastic and not compromised with the EMV. We can target the dominant eye for plano or first minus, and in the nondominant eye we do not need to offset that –1.5 D or –1.25 D for a full monovision target—because the eyes blend. You don’t lose the depth of perception. The reading eye still sees good for distance and the distance eye still sees a little better for intermediate vision.”

OPTIMAL CANDIDATES

With a growing array of IOL choices on the market, today’s surgeons can truly customize the patient’s lens solution. In the case of RayOne EMV, several factors should be taken into account when finding optimal patients.

Dr. Stonecipher believes that the best candidates are those who can tolerate monovision and who have normal corneas. His preferred approach is to correct the first eye for distance and use blended vision to improve intermediate and near vision. He calls this a “best of both worlds scenario” and says patient satisfaction has been high.

Dr. Labor says that he is making the RayOne EMV lens available to any patient who is interested in presbyopia correction but perhaps cannot afford a premium option.

“RayOne EMV should be treated as a standard monofocal lens in regard to patient selection criteria,” he continues. “It can be used in virtually any healthy eye. It should not be used in patients with significant ocular surface disease or with either too much or irregular astigmatism. In my experience, as long as you are following Rayner’s guidelines and choosing the right patient, this is going to be a success. Patients do really well.”

Dr. Labor says it makes sense to start with patients who have no significant ocular comorbidities and a cylinder no greater than three-quarters of a diopter. Then, surgeons can work their way toward more correction.

“In terms of the actual implantation of the lens, the preloaded format is convenient,” he adds. “Any surgeon not already familiar with a push plunger should be slow and steady. I have learned that withdrawing the injector nozzle slightly can help while aiding placement. Insert the OVD [ophthalmic viscosurgical device] just prior to implantation rather than filling the cartridge and just leaving it on the back table. This will increase your control and feel. The lens can be a bit more difficult to insert otherwise.”

As with any other IOL, Dr. Labor warns that setting expectations in advance is critical. “I can’t stress the old adage of ‘under-promise, over-deliver’ enough in the case of IOLs,” he says. “Patients must understand that if they’re going to be reading for a long time, they will likely still need a low-add reader. In fact, I even make them sign something stating that they understand this. But with reasonable expectations going into the process, patients have been incredibly pleased. In fact, despite what I’ve mentioned about needing corrective lenses for prolonged near work, many tell me they spend most of their day with spectacle independence.” ■