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Optics for the New Millennium pp 397–414Cite as

What’s on the Menu: An Overview of Currently Available IOLs and Relevant Optics

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Abstract

This chapter primarily focuses on clinically and surgically relevant optics of commonly used intraocular lenses (IOLs). The reader will be introduced to the optics of IOL materials, edge design, and optic architecture. A comparison of spherical versus aspheric IOLs will be presented. Next, a comprehensive review of monofocal IOLs will be discussed, including comparing similarities and differences between commonly implanted IOLs. A brief discussion regarding three-piece and anterior chamber IOLs will also be given. Finally, a thorough discussion on the optics of advanced technology IOLs (ATIOLs), toric and presbyopia-correcting, will be provided, including a section for the reader to understand how to assess ATIOL performance when reading the literature objectively.

Keywords

  • Acrylic
  • Silicone
  • Collamer
  • Index of refraction
  • Dysphotopsias
  • Posterior capsule opacification (PCO)
  • Monofocal IOL
  • Hydrophobic IOL
  • Hydrophilic IOL
  • Rounded-edge IOL
  • Square-edge IOL
  • Haptic-optic planarity
  • Edge-to-edge power
  • Inert carrier
  • C-shaped haptic
  • Single-piece acrylic (SPA) IOL
  • Biconvex IOL
  • Convex-plano IOL
  • Spherical IOL
  • Aspheric IOL
  • Spherical aberration
  • IOL power standards
  • Three-piece IOLs
  • Extended range IOLs
  • Piggyback IOL
  • Anterior chamber IOL
  • Toric IOL
  • Under-correction
  • Corneal astigmatism
  • Advanced technology IOL (ATIOL)
  • Presbyopia-correcting IOL
  • Diffraction
  • Wavelength
  • Diffractive multifocal IOL (MFIOL)
  • Apodized diffractive MFIOL
  • Non-apodized diffractive MFIOL
  • Refractive IOL
  • Extended depth of focus (EDOF) IOL
  • Diffractive optics EDOF IOL
  • Echelettes
  • Chromatic aberration
  • Mix and match
  • Modified wavefront EDOF IOL
  • Trifocal IOL
  • Accommodative IOL
  • Z-syndrome
  • Modular transfer function (MTF)
  • Defocus curves

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Notes

  1. 1.

    This may be especially difficult for trainees to keep up with. After finishing training in 2013, this author himself has seen the introduction of multiple monofocal IOLs; two new toric IOLs; three new diffractive multifocal IOLs; two extended depth of focus IOLs (one using diffractive optics and the other using wave front modification optics); one trifocal IOL; and one monofocal-plus IOL.

  2. 2.

    It is said the idea of implanting an intraocular lens came to Harold Ridley after an intern asked him why he was not replacing the lens he had removed during cataract surgery. The acrylic plastic material was chosen because Ridley noticed it was inert after seeing RAF (Royal Air Force) pilots of World War II with pieces of shattered canopies in their eyes. See Williams HP. Sir Harold Ridley’s vision. Br J Ophthalmol. 2001 Sep;85(9):1022-3.

  3. 3.

    See Chap. 1, Geometric Optics for a discussion of how the index of refraction (and good ole Snell’s Law) may affect the incidence and severity of dysphotopsias. Dysphotopsias are additionally discussed in Chap. 29, Postoperative Optics for Cataract Surgery

  4. 4.

    Linnola RJ, Werner L, Pandey SK, et al. Adhesion of fibronectin, vitronectin, laminin and collagen type IV to intraocular lens materials in human autopsy eyes. Part I: histological sections. J Cataract Refract Surg 2000; 26:1792-180

  5. 5.

    Zhao Y, Yang K, Li J, Huang Y, Zhu S. Comparison of hydrophobic and hydrophilic intraocular lens in preventing posterior capsule opacification after cataract surgery: An updated meta-analysis. Medicine (Baltimore). 2017 Nov;96(44):e8301.

  6. 6.

    Heatley CJ, Spalton DJ, Kumar A, Jose R, Boyce J, Bender LE. Comparison of posterior capsule opacification rates between hydrophilic and hydrophobic single-piece acrylic intraocular lenses. J Cataract Refract Surg. 2005 Apr;31(4):718-24.

  7. 7.

    Iwase T, Nishi Y, Oveson BC, Jo YJ. Hydrophobic versus double-square-edged hydrophilic foldable acrylic intraocular lens: effect on posterior capsule opacification. J Cataract Refract Surg. 2011 Jun;37(6):1060-8.

  8. 8.

    Dorey MW, Brownstein S, Hill VE, Mathew B, Botton G, Kertes PJ, El-Defrawy S. Proposed pathogenesis for the delayed postoperative opacification of the hydroview hydrogel intraocular lens. Am J Ophthalmol. 2003 May;135(5):591-8.

  9. 9.

    Of note, the Envista MX60/MX60E (Bausch and Lomb, Tampa, FL, USA) has approximately 5% water content.

  10. 10.

    For example, the Rayner C-flex and Superflex (Rayner Intraocular Lenses, Ltd., West Sussex, United Kingdom)

  11. 11.

    Qiu X, Wu Y, Jiang Y, Ji Y, Zhu X, Yang J, Lu Y. Management and Microbiological Characteristics of Membrane Formation on a Hydrophilic Acrylic Intraocular Lens: A Clinical Case Series and Material Comparative Study of Different IOLs. J Ophthalmol. 2019 Feb 3;2019:5746186.

  12. 12.

    Some may argue that PCO formation is a good thing because it allows you to do another billable procedure. Don’t be that guy or gal!

  13. 13.

    See Chap. 29, Postoperative Optics for Cataract Surgery, for a detailed discussion on dysphotopsias

  14. 14.

    Personal communication, Thomas Olsen, MD and David L. Cooke, MD, March 7, 2021.

  15. 15.

    Another, more memorable mnemonic is if you see the “S”, then “you need to fix it, stupid.”

  16. 16.

    The last of this type of IOLs was the MC70CM 3 piece convex-plano PMMA IOL (Alcon Laboratories, Fort Worth, TX, USA) with a 7.0 mm optic. Currently available anterior chamber IOLs, such as the MTAXUO series, are convex-plano IOLs.

  17. 17.

    Currently available models of spherical IOLs include the SN60AT/SA60AT (SPA) (Alcon Laboratories, Fort Worth, TX USA) and Sensar AAB00 (SPA) and AR40 (three-piece) series (both from Johnson and Johnson Vision, Jacksonville, FL, USA)

  18. 18.

    An exception to this is the Envista MX60(E) series (Bausch and Lomb, Tampa, FL, USA) which is a zero-aberration (aberration-free) aspheric IOL.

  19. 19.

    Don’t worry if you don’t understand this paragraph on the first read. It takes several readings to fully digest this material.

  20. 20.

    Recall the inverse relationship between spherical aberration and contrast sensitivity: reduction of spherical aberration will improve contrast sensitivity. See Chap. 14, “Physical Optics and Advanced Optical Principles” for more information.

  21. 21.

    Riaz KM, Williams BL, Safran SG, Gallardo MJ. Proliferative Anterior Optic Membranes in Hydrophobic Acrylic Intraocular Lenses. Clin Ophthalmol. 2020 Oct 22;14:3451-3455.

  22. 22.

    See Chap. 28, Intraoperative Optics for Cataract Surgery, for additional information regarding sulcus IOLs (e.g., sulcus IOL power calculations, types of placement, etc.)

  23. 23.

    Suelves AM, Siddique SS, Schurko B, et al. Anterior chamber intraocular lens implantation in patients with a history of chronic uveitis: five-year follow-up. J Cataract Refract Surg. 2014;40(1):77-81.

  24. 24.

    IOLs that combine presbyopia- and astigmatism-correction are discussed in the next section.

  25. 25.

    Yes, that sounds morbid so apologies in advance!

  26. 26.

    Remember how we spent time discussing refraction and diffraction back in Chap. 1, “Geometric Optics?” It may be worthwhile to review these definitions before proceeding further.

  27. 27.

    A useful rule in life: whenever you want to sound intelligent, use a French-origin word and people will think you are a genius.

  28. 28.

    One way to understand “stretching and shifting” is to understand that a transition element in the central part of this IOL stretches the incoming wavefront in the X-Y direction; a second transition element shifts the incoming wavefront in the Z direction. The combination of this “stretch and shift” creates EDOF optics.

  29. 29.

    “Patient Information Brochure”. https://www.accessdata.fda.gov/cdrh_docs/pdf/P930014S126D.pdf. Accessed January 9, 2021.

  30. 30.

    Lee S, Choi M, Xu Z, et al. Optical bench performance of a novel trifocal intraocular lens compared with a multifocal intraocular lens. Clin Ophthalmol. 2016;10:1031-1038.

  31. 31.

    A certain percentage of incoming light is lost with an ATIOL due to absorption and destructive interference: think of this as “wasteful” government spending in the above analogy. This should not be interpreted as a political statement of any kind.

Acknowledgments

The author is very grateful to David L. Cooke, MD (Great Lakes Eye Care, St. Joseph, MI) for his editorial assistance and critical review of the material presented in this chapter.

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Authors and Affiliations

  1. Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA

    Kamran M. Riaz

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  1. Kamran M. Riaz
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Editors and Affiliations

  1. Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA

    Kamran M. Riaz

  2. Clinical Pediatrics and Ophthalmology Georgetown University Hospital, Washington, DC, USA

    G. Vike Vicente

  3. Center for Sight, Stockton, CA, USA

    Daniel Wee

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Riaz, K.M. (2022). What’s on the Menu: An Overview of Currently Available IOLs and Relevant Optics. In: Riaz, K.M., Vicente, G.V., Wee, D. (eds) Optics for the New Millennium. Springer, Cham. https://doi.org/10.1007/978-3-030-95251-8_27

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