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Up Front | Mar 2011


Cataract surgeons are still waiting for the Holy Grail—the truly accommodating IOL—but in the meantime we continue to choose the best implant for each individual patient from the range of IOLs available today. Current single-optic accommodating designs are encountering growing skepticism in the field, and dual-optic accommodating IOLs need more evaluation and longer-term follow-up to convince most surgeons of their utility in daily practice.

Although multifocal IOLs have already acquired a sizable market share, their use varies significantly among countries and individual practices. Factors such as culture, financial issues, and surgeon expertise greatly influence the penetration of multifocal lenses. In this Annual IOL Issue, Michael C. Knorz, MD, shares his pearls for success with premium IOLs. From his article, it is clear that patient counseling and surgical details are different for multifocal IOLs compared with monofocal IOLs. In another article, Tanja M. Rabsilber, MD, and Gerd U. Auffarth, MD, describe the history of multifocal IOLs and the optical principles of the IOLs on the market today. Like Dr. Knorz, they conclude that management of patient expectations is a key factor for success. Frank J. Goes, MD, shares results from the Happy Patients Project, an iniative started in Germany and Belgium to study the use of psychometric patient profiles for identifying suitable patients for multifocal IOL implantation.

The chief drawback of having a multifocal implant in one’s eye, reduced contrast sensitivity, has a significant influence on the members of our Editorial and Global Advisory Boards. When asked for their preference for their own cataract surgery implant, two out of nine responding to our poll say they would choose a multifocal lens; no one opts for an accommodating IOL, and seven say they would choose a monofocal IOL with some degree of monovision.

Kimiya Shimizu, MD, PhD, shares with us his experience and research on how monovision has changed over the past 10 years. Many respected key opinion leaders now use a mini-, moderate, or other forms of monovision as their preferred strategy to address presbyopia. I recently heard Dr. Shimizu state that he has abandoned the use of presbyopia-correcting IOLs.

Guenal Kahraman, MD, PhD, and Michael Amon, MD, propose an interesting strategy of implanting a multifocal IOL in the sulcus in addition to a monofocal IOL in the bag. (Dr. Amon designed the Sulcoflex [Rayner Intraocular Lenses Ltd., East Sussex, United Kingdom] add-on lens.) This strategy provides a relatively atraumatic escape route to explant the sulcus-fixated multifocal lens if required. I endorse this basic strategy, but more development work must be done before this will be widely accepted by other surgeons.

Phakic implants are also gaining popularity among cataract and refractive surgeons alike. Dimitrii Dementiev, MD, provides his personal experience with these lenses.

One specific topic is of special interest to me: hydrophobic acrylic lens materials. Numerous new hydrophobic acrylic materials and IOL designs have been introduced in recent years, and more will be launched soon in the European market. I asked Steele McIntyre, MD, Liliana Werner, MD, PhD, and Nick Mamalis, MD, of the University of Utah, to write an overview article on hydrophobic acrylic materials and their clinical properties. I recommend reading this extensive article, which gives insight into the numerous variables involved. Additionally, in my own article on the same topic, I have tried to cover the fundamentals of hydrophobic material constituents and manufacturing processes and their potential affect on IOL performance. This subject may not interest the average clinician, but in my opinion it deserves more attention, as IOL material and design are the most important factors in determining patient outcomes.

We hope you enjoy this Annual IOL Issue, and we promise to keep you updated on developments in this field in the coming months and years. â– 

Khiun F. Tjia, MD, Chief Medical Editor