I am extremely excited about the ArtIOLs (Voptica), a new-technology IOL that I designed and that is already being implanted. The ArtIOLs targets two key areas to improve retinal image quality. This new type of IOL provides customized extended depth of focus (EDOF) by optimizing spherical aberration for each patient and visual condition. The ArtIOLs comes in four models—the ArtIOLs25, ArtIOLs40, ArtIOLs55, and ArtIOLs70—each of which has a different spherical aberration net value.

The best lens for a given patient can be identified by using the Adaptive Optics Visual simulator (VAO; Voptics), an instrument that also allows the patient to test different optical solutions before surgery. The patient can try each asphericity before surgery, and the best lens can be chosen depending on his or her visual needs and tolerances.

The ArtIOLs also has a unique meniscus shape, which is designed to provide better peripheral optical image quality in the peripheral retina than other IOLs currently on the market. An ArtIOLs can improve field curvature and reduce peripheral astigmatism.

Research has yet to demonstrate the visual consequences of improved peripheral vision in a pseudophakic eye, but I anticipate that better peripheral vision will reduce the risk of falls and, possibly, road accidents.”

Regarding multifocal IOLs, trifocal diffractive lenses are, in 2020, the gold standard for the correction of presbyopia after lens surgery. Trifocal IOLs do, however, have both pros and cons. These IOLs provide a broader range of vision compared with other lens types, but they can also cause undesirable visual effects that are occasionally unacceptable to certain patients and are not recommended for certain activities. Trifocal IOLs are contraindicated under certain clinical or anatomic circumstances, and, at times, logistical and/or economic limitations preclude the implantation of a trifocal IOL.

Most of the trifocal diffractive IOLs currently available on the market perform similarly with regard to visual outcomes, patient satisfaction, and spectacle-independence outcomes. The differences between the various options are based on the material and design of the lens platform used in the IOL’s manufacturing, the amount of light distributed to each of the three foci, and, to a lesser extent, the calculated add power for intermediate vision.

Studies conducted at Clinica Baviera, a multicenter and multisurgeon ophthalmic institution in Madrid, Spain, have evaluated most of the trifocal lenses available on the market. Among the ‘classic’ trifocal models, my favorite platform is the FineVision (Micro F, PhysIOL) with which my colleagues and I have achieved excellent visual, refractive, and anatomic results. During more than 7 years of experience with this lens, I have found that the IOL’s four closed haptics enhance the predictability of the effective lens position and that the lens is very comfortable to insert, has excellent centration and stability in the bag, and is associated with a very low rate of posterior capsular opacification.

I am really excited to obtain initial clinical results for two new models: the FineVison Triumf (PhysIOL) and the Tecnis Synergy (Johnson & Johnson Vision). I can’t wait to see what kinds of additional advantages these IOLs can provide to patients. The FineVison Triumf IOL has a new diffractive trifocal profile that is designed to provide greater energy light distribution for intermediate vision and correct longitudinal chromatic aberration. The Tecnis Synergy IOL, on the other hand, combines the traditional diffractive and echelette designs.

Extended depth of focus (EDOF) IOLs have been available for several years now, and they are intended to provide better and broader intermediate vision compared with monofocal IOLs—theoretically without the unwanted photic phenomena and loss of contrast sensitivity associated with multifocal IOLs. Previous EDOF models, however, have failed to achieve these goals. They were found not to provide superior intermediate vision, and they induced similar dysphotopsias and worse near vision than trifocal IOLs. This may be because many EDOF IOLs are based on low-addition bifocal diffractive or segmental refractive optic properties. In my experience, results with EDOF IOLs have been somewhat disappointing.

My colleagues and I at Clinica Baviera are currently performing initial clinical evaluation studies of newer EDOF IOL models such as the xact Mono-EDOF (Santen), the AT LARA (Carl Zeiss Meditec), the Lucidis (Swiss Advanced Vision), the Tecnis Eyhance (Johnson & Johnson Vision), the Vivity (Alcon), and the IsoPure (PhysIOL). I am especially excited about the last three models listed, which were designed on the principle that spherical aberration can enhance depth of field. My initial personal experience with the IsoPure IOL has been extremely promising. The IsoPure can provide virtually the same distance vision and contrast sensitivity results as a monofocal IOL—without causing dysphotopic phenomena and with an optical system less sensitive to defocus—while also offering a continuous visual field between distance and intermediate vision.”

Newly available IOLs and those still on the horizon allow us to fulfill our patients’ needs for spectacle independence. The Tecnis Eyhance IOL shows promise for increasing depth of field and correcting both distance and intermediate vision without causing problems with night vision. The continuous range of vision from distance to near provided by the Tecnis Synergy IOL allows many patients to achieve spectacle independence and may be slightly more effective than currently available trifocal IOLs. Anterior capsule-fixated IOLs provide stable centration and placement and may be an excellent choice for toric platforms given the advantage of reduced negative dysphotopsia. The Light Adjustable Lens (RxSight) introduces the ability to adjust IOL power postoperatively in order to achieve emmetropia; I am very excited about this IOL.”

A variety of advanced IOL technologies are being developed right now. Novel concepts include moving optics, oil-filled chambers that change with an accommodative response, nanotechnology, light-adjustable IOLs, and many more.

One very exciting concept is the Excelens system (Excelens). It is designed to permit in-office postoperative fine-tuning of the refractive outcome. The optics can be chosen according to the patient’s wishes—monofocal to monofocal toric to multifocal and multifocal toric.

With the Excelens system, there is a cradle in which the IOL lies, a ratchet mechanism, and nitinol threads. Nitinol is a metal that has a “memory,” meaning it resumes its shape with changing temperature. The tension of the nitinol will change during an Nd:YAG laser procedure, pushing the IOL over the ratchet mechanism in measured steps. This movement can be anterior to posterior to adjust spherical power or radial to adjust cylindrical power.

This mechanism can permit postoperative adjustment of refractive power without requiring an IOL exchange or an expensive laser procedure. Additionally, changes in refraction occurring during the patient’s life cycle can be addressed in the same manner; should a patient develop against-the-rule astigmatism, a small in-office procedure can enable adjustment of the IOL.”