Summary
There is a sea-change in cataract/lens implant (IOL) surgery. More than ever before, patients with cataracts want to able to see well without the need for glasses or contact lenses. Standard IOLs give very good vision, but many patients have pre-existing astigmatism and need correction for that with a Toric IOL, and those who want to see well for distance and near will require either a multifocal IOL (Alcon ReStor, AMO ReZoom or Technis ZM900 IOL) or an accommodative IOL (Bausch and Lomb Crystalens). Alcon's two IOLs, their Acrysof Toric IOL for astigmatism, and their newest multifocal IOL, the Alcon ReStor +3.0 D are showing good usage With respect to astigmatism, the two existing IOLs are the Staar Toric IOL and the Alcon Toric IOL, both of which work well. The multifocal Aspheric Alcon ReStor + 3.00 D is showing strong penetration because the + 3.00 D add allows for intermediate (computer vision) as well as near vision and less haloes and glare .
Analysis
(Expanded and in-depth version of Toric and Multifocal IOL analysis)
There is a sea-change in cataract/lens implant (IOL) surgery. More than ever before, patients with cataracts want to able to see well without the need for glasses or contact lenses. Standard IOLs give very good vision, but many patients have pre-existing astigmatism and need correction for that with a Toric IOL, and those who want to see well for distance and near will require either a multifocal IOL (Alcon ReStor, AMO ReZoom or Technis IOL) or an accommodative IOL (Bausch and Lomb Crystalens).
Alcon has two compelling IOLs with their highly successful Acrysof Toric IOL for astigmatism, and their newest multifocal IOL, the Alcon ReStor +3.0 D.
With respect to astigmatism, the two existing IOLs for this are the Staar Toric IOL and the Alcon Toric IOL. both of which work well.
The original Staar Toric IOL had the disadvantage of sometimes rotating in the days or weeks after the original eye surgery, sometimes requiring a second surgery to reposition the IOL in the correct astigmatic meridian. The newer version of the Staar Toric IOL stays in position miuch better, with less rotation., The Alcon Toric IOL, by virtue of being made from the same material (soft polymethylmethacrylate), has an inherent "stickiness" which prevents rotation and is therefore much more stable in the eye. Alcon also has provided, free of charge, an on-line Toric IOL Calculator program, which enables the surgeon seamlessly to select the correct IOL power and put it in the correct astigmatic axis. The Calculator presents a visual image of thge IOL as it should reside in the eye, denoting power and insertion meridian.The Alcon Toric IOL is the current market leader for astigmatism IOL surgery.
With respect to multifocal IOLs, the Alcon ReStor + 3.00 D is showing strong penetration because the + 3.00 D add allows for intermediate (computer vision) as well as near vision. The Alcon ReStor is on the same platform as the market share leading standard monofocal IOL, the Alcon Acrysof (soft polymethylmethacrylate). This IOL material is familiar to many surgeons who implant the Alcon Acrysof as their standard IOL of choice. The original Alcon ReStor (the +4.0D) provides very good distance and close up (needlepoint, book reading) vision but is weaker at computer distances. This newer + 3.00 D version does not sacrifice the near and creates much better intermediate vision (computers) while retaining its excellent distance effort. In addition, it has an Aspheric platform, so there is less halo and glare at night (scotopic conditions)
The Tecnis TM ZM900 Multifocal IOL and the Bausch and Lomb Crystalens are also commonly used and perform well. The AMO ReZoom provides good distance and intermediate vision, but is weaker for near vision. The Tecnis multifocal is an excellent choice as well, with a shorter track record. ZM900 Tecnis is getting strong interest.
B and L has updated and upgraded its Crystalens accommodating IOL to the HD series, with a larger central optic and better flexing characteristics.
. None of these IOLs is perfect, as there can be some halo and glare at night and dusk conditions with some of them, and vision is not optimal at all distances with any of them. For example, the AMO ReZoom has good intermediate and distance vision, but not as good near vision. The Crystalens provides very good distance and intermediate vision but not as strong a near vision effect, and is a bit more cumbersome to implant than the Alcon ReStor, the AMO ReZoom or Tecnis ZM900 multifocal IOL. The original Alcon +4.0D ReStor suffers a bit from weaker intermediate (computer) vision, but is strong at distance and near, with minimal halo. The Aspheric Alcon ReStor +3.0D has improved the intermediate power, while not sacrificing its excellent distance and reading power, and is on the Aspheric platform to improve night and dusk driving.
Overall these newest IOLs are changing the landscape for IOL surgery, as they are creating more options for value-added purchase by our patients to improve their quality of life.
