Abstract
Purpose of Review
Advances in intraocular lens (IOL) design for cataract surgery have led to improved visual acuity outcomes and spectacle independence. There are innovative designs that have recently become available, including extended depth of focus, multifocal, and light-adjustable lens, and new technologies on the horizon such as modular IOLs. The objective of this review is to outline the current state of premium IOLs on the market and present outcome data to assess their benefits and limitations. This review will also explore premium IOLs in development.
Recent Findings
Extended depth of focus (EDOF) IOLs improve functional vision over a range of distances and correct for presbyopia by creating a single, elongated focus. The IC-8 (AcuFocus) uses a small aperture and provides a promising option for patients with irregular refractive states. The AcrySof Vivity (Alcon) uses a shifting wavefront to allow extended depth of focus while reducing dysphotopsias, and the Tecnis Eyhance (J&J) uses a progressive power change to improve intermediate distance visual acuity. Multifocal IOLs such as the PanOptix (Alcon) provide effective intermediate and near visual acuity but the use of diffraction results in increased photic effects. The Tecnis Synergy (J&J) combines multifocal and EDOF technology to provide a wider range of functional focus. The development of light-adjustable lens such as RxSight makes it possible to adjust lens power postoperatively using ultraviolet irradiation. Modular IOLs are a new generation of IOLs in the pipeline that have a multiple component design to enable easier optic exchange. The Juvene (LensGen) has received investigational device exemption approval from the FDA and other modular IOLs such as Harmoni and Gemini are also in development.
Summary
Innovations in IOLs are providing increased options for presbyopia correction and reducing refractive error after cataract surgery. As new IOLs are being developed to provide improved functional vision over a range of distances with minimal aberrations, patient selection remains critical to ensure improved visual outcomes and high levels of patient satisfaction.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: •Of importance
Dick HB, Piovella M, Vukich J, Vilupuru S, Lin L, Clinical Investigators. Prospective multicenter trial of a small-aperture intraocular lens in cataract surgery. J Cataract Refract Surg. 2017;43(7):956–68. https://doi.org/10.1016/j.jcrs.2017.04.038.
Yang LWY, Ong HS, Chiam N, Mehta JS. Centration and stability of small-aperture intraocular lens in aberrated eyes. J Refract Surg. 2022;38(2):98–105. https://doi.org/10.3928/1081597X-20211116-02.
•Ang RE. Visual performance of a small-aperture intraocular lens: first comparison of results after contralateral and bilateral implantation. J Refract Surg. 2020;36(1):12–9. https://doi.org/10.3928/1081597X-20191114-01 (Understanding visual effects of bilateral and contralateral implantation of the IC-8 IOL, including visual acuity, visual symptoms, defocus curves, contrast sensitivity and patient satisfaction).
Dick HB. Small-aperture strategies for the correction of presbyopia. Curr Opin Ophthalmol. 2019;30(4):236–42. https://doi.org/10.1097/ICU.0000000000000576.
Gundersen KG, Potvin R. Clinical outcomes and quality of vision associated with bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens. Clin Ophthalmol. 2021;15:4723–30. https://doi.org/10.2147/OPTH.S342947.
•Lopes D, Loureiro T, Carreira R, et al. Comparative evaluation of visual outcomes after bilateral implantation of an advanced or conventional monofocal intraocular lens. Eur J Ophthalmol. 2022;32(1):229–34. https://doi.org/10.1177/1120672121995343 (Assessing visual acuity outcomes and capability for intermediate distance activities for the Tecnis Eyhance IOL compared to a conventional monofocal IOL).
de Luis Eguileor B, Martínez-Indart L, Martínez Alday N, Sacristán Egüén C, Cuadros Sánchez C. Differences in intermediate vision: monofocal intraocular lenses vs. monofocal extended depth of focus intraocular lenses. Diferencias en la visión intermedia: lente intraocular monofocal vs. lente intraocular monofocal de rango extendido. Arch Soc Esp Oftalmol. 2020;95(11):523–7. https://doi.org/10.1016/j.oftal.2020.06.009.
Unsal U, Sabur H. Comparison of new monofocal innovative and standard monofocal intraocular lens after phacoemulsification. Int Ophthalmol. 2021;41(1):273–82. https://doi.org/10.1007/s10792-020-01579-y.
Auffarth GU, Gerl M, Tsai L, et al. Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract. J Cataract Refract Surg. 2021;47(2):184–91. https://doi.org/10.1097/j.jcrs.0000000000000399.
Cinar E, Bolu H, Erbakan G, et al. Vision outcomes with a new monofocal IOL. Int Ophthalmol. 2021;41(2):491–8. https://doi.org/10.1007/s10792-020-01599-8.
•Cochener B; Concerto Study Group. Clinical outcomes of a new extended range of vision intraocular lens: International Multicenter Concerto Study. J Cataract Refract Surg. 2016;42(9):1268–75. https://doi.org/10.1016/j.jcrs.2016.06.033 (Evaluating outcomes of the Tecnis Symfony IOL for visual performance, photic phenomena, spectacle independence and patient satisfaction).
Vryghem JC, Heireman S. Visual performance after the implantation of a new trifocal intraocular lens. Clin Ophthalmol. 2013;7:1957–65. https://doi.org/10.2147/OPTH.S44415.
Cochener B, Vryghem J, Rozot P, Lesieur G, Chevalier J-P, Henry J-M, David T, Lesueur L, Gatinel D, Ganem C, Blanckaert J, Van Acker E, Heireman S, Ghekiere S. Clinical outcomes with a trifocal intraocular lens: a multicenter study. J Refract Surg. 2014;30:762–8.
Ribeiro FJ, Ferreira TB, Silva D, Matos AC, Gaspar S. Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and multifocal profiles. J Cataract Refract Surg. 2021;47(11):1448–53.
Shin DE, Lee H, Kim TI, Koh K. Comparison of visual results and optical quality of two presbyopia-correcting intraocular lenses: TECNIS symfony versus TECNIS synergy. Eur J Ophthalmol. 2022. https://doi.org/10.1177/11206721221093024.
Ferreira TB, Ribeiro FJ, Silva D, Matos AC, Gaspar S, Almeida S. Comparison of refractive and visual outcomes of 3 presbyopia-correcting intraocular lenses. J Cataract Refract Surg. 2022;48(3):280–7. https://doi.org/10.1097/j.jcrs.0000000000000743.
Dick HB, Ang R, Corbett D, et al. Comparison of 3-month visual outcomes of a new multifocal intraocular lens versus a trifocal intraocular lens. J Cataract Refract Surg. 2022. https://doi.org/10.1097/j.jcrs.0000000000000971.
•Calladine D, Evans JR, Shah S, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev 2012:CD003169. Review of visual outcomes of multifocal IOLs compared to monofocal lenses, including visual acuity, spectacle dependence and subjective satisfaction
Ravikumar S, Bradley A, Thibos LN. Chromatic aberration and polychromatic image quality with diffractive multifocal intraocular lenses. J Cataract Refract Surg. 2014;40(7):1192–204. https://doi.org/10.1016/j.jcrs.2013.11.035.
•Modi S, Lehmann R, Maxwell A, et al. Visual and patient-reported outcomes of a diffractive trifocal intraocular lens compared with those of a monofocal intraocular lens. Ophthalmology. 2021;128(2):197–207. https://doi.org/10.1016/j.ophtha.2020.07.015 (Assessing safety and effectiveness of the Alcon PanOptix IOL, including visual acuity and frequency of visual disturbances).
Montés-Micó R, España E, Bueno I, Charman WN, Menezo JL. Visual performance with multifocal intraocular lenses: mesopic contrast sensitivity under distance and near conditions. Ophthalmology. 2004;111(1):85–96. https://doi.org/10.1016/S0161-6420(03)00862-5.
Blehm C, Potvin R. Reported Patient Satisfaction and Spectacle Independence Following Bilateral Implantation of the PanOptix® Trifocal Intraocular Lens. Clin Ophthalmol. 2021;15:2907–12. https://doi.org/10.2147/OPTH.S323337.
Kohnen T, Marchini G, Alfonso JF, et al. Innovative trifocal (quadrifocal) presbyopia-correcting IOLs: 1-year outcomes from an international multicenter study. J Cataract Refract Surg. 2020;46(8):1142–8. https://doi.org/10.1097/j.jcrs.0000000000000232.
Shatz AC, Potvin R. Spectacle independence and quality of vision after bilateral implantation of a trifocal intraocular lens. Clin Ophthalmol. 2021;15:2545–51. https://doi.org/10.2147/OPTH.S318203.
•Cochener B, Boutillier G, Lamard M, Auberger-Zagnoli C. A comparative evaluation of a new generation of diffractive trifocal and extended depth of focus intraocular lenses. J Refract Surg. 2018;34(8):507–14. https://doi.org/10.3928/1081597X-20180530-02 (Comparing visual acuity, spectacle independence and visual symptoms of trifocal and EDOF IOLs).
Donmez O, Asena BS, Kaskaloglu M, Akova YA. Patients satisfaction and clinical outcomes of binocular implantation of a new trifocal intraocular lens. Int Ophthalmol. 2020;40(5):1069–75. https://doi.org/10.1007/s10792-020-01390-9.
Kohnen T, Lwowski C, Hinzelmann L, et al. Presbyopia correction in astigmatic eyes using a Toric trifocal intraocular lens with quadrifocal technology. J Refract Surg. 2020;36(10):638–44. https://doi.org/10.3928/1081597X-20200729-04.
Spiegle S. Presbyopic IOLs in the Pipeline. Review of Ophthalmology. 2022. https://www.reviewofophthalmology.com/article/presbyopic-iols-in-the-pipeline
•Dick HB, Gerste RD. Future intraocular lens technologies. Ophthalmology. 2021;128(11):206–13. https://doi.org/10.1016/j.ophtha.2020.12.025 (Review of recent innovations in intraocular lens technology, including presbyopia-correcting lens and light-adjustable lens).
Summary of Safety and Effectiveness Data (SSED) P160055: Light Adjustable Lens (LAL)/Light Delivery Device (LDD). United States Food and Drug Administration. 2017.
What to Expect Following Your Cataract Surgery. RxSight. Accessed online June 2022. https://www.rxsight.com/us/what-to-expect/
Schojai M, Schultz T, Schulze K, Hengerer FH, Dick HB. Long-term follow-up and clinical evaluation of the light-adjustable intraocular lens implanted after cataract removal: 7-year results. J Cataract Refract Surg. 2020;46(1):8–13. https://doi.org/10.1016/j.jcrs.2019.08.011.
MacLean KD, Werner L, Kramer GD, et al. Evaluation of stability and capsular bag opacification of a new foldable adjustable intraocular lens. Clin Exp Ophthalmol. 2015;43(7):648–54. https://doi.org/10.1111/ceo.12526.
•Ang RET, Yoo P, Liu J. Visual outcomes after optic exchange of a modular intraocular lens. J Cataract Refract Surg. 2021;47(11):1441–7. https://doi.org/10.1097/j.jcrs.0000000000000654 (Assessing the effectiveness of the Harmoni Modular IOL in comparison with a standard IOL implanted in the contralateral eye).
SooHoo JR, Lane SS, Cionni RJ, Berdahl JP, Sussman GR, Kahook MY. Comparison of stability between a modular intraocular lens system and a single-piece hydrophobic acrylic intraocular lens. J Cataract Refract Surg. 2016;42(12):1821–5. https://doi.org/10.1016/j.jcrs.2016.09.022.
Ang RET, Yoo P, Liu J. Evaluation of safety after optic exchange of a modular intraocular lens. J Cataract Refract Surg. 2021;47(10):1273–8. https://doi.org/10.1097/j.jcrs.0000000000000628.
Mittal A, Garg S. What new lens technologies are on the horizon? touchRev Ophthalmol. 2021;15(1):6–8.
Kohl JC, Werner L, Ford JR, et al. Long-term uveal and capsular biocompatibility of a new accommodating intraocular lens. J Cataract Refract Surg. 2014;40(12):2113–9. https://doi.org/10.1016/j.jcrs.2014.10.011.
Garg S, De Jesus MT, Laura MF, Chayet A, Barragán E, Casey P. Twelve-month clinical outcomes after implantation of a novel, modular, anterior shape-changing fluid optic intraocular lens. J Cataract Refract Surg. 2022. https://doi.org/10.1097/j.jcrs.0000000000000935.
•Gibbons A, Ali TK, Waren DP, Donaldson KE. Causes and correction of dissatisfaction after implantation of presbyopia-correcting intraocular lenses. Clin Ophthalmol. 2016;10:1965–70. https://doi.org/10.2147/OPTH.S114890 (Understanding primary causes of patient dissatisfaction after presbyopia-correcting IOL implantation).
McMahon JF. Extended Depth of Focus IOLs. American Academy of Ophthalmology EyeWiki. March 4, 2022. https://eyewiki.aao.org/Extended_Depth_of_Focus_IOLs. Accessed 18 Aug 2022
Alcon Announces Launch of AcrySof IQ Vivity, the First and Only Non-Diffractive Extended Depth of Focus Intraocular Lens in the U.S. 2021. Available at: https://www.alcon.com/media-release/alcon-announces-launch-acrysof-iq-vivity-first-and-only-non-diffractive-extended. Accessed August 18, 2022.
Alcon Introduces AcrySof IQ PanOptix Trifocal IOL in the U.S., the First and Only FDA-Approved Trifocal Lens. 2019. Available at: https://investor.alcon.com/news-and-events/press-releases/news-details/2019/Alcon-Introduces-AcrySof-IQ-PanOptix-Trifocal-IOL-in-the-US-the-First-and-Only-FDA-Approved-Trifocal-Lens/default.aspx. Accessed 18 Aug 2022.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interest for any author.
Research Involving Human Participants or Animals
This study was a review and did not involve human participants or animals.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical collection on Ophthalmologic Surgery.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Xiao, G., Sulewski, M.E. & Woreta, F.A. Current Advances and Future of Premium IOLs. Curr Surg Rep 10, 223–230 (2022). https://doi.org/10.1007/s40137-022-00333-w
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40137-022-00333-w