Cataract and refractive surgeons attending a breakfast at AUSCRS gained real-world and clinical trial insights into the technology behind premium intraocular lenses (IOLs) with a specific focus on two extended depth of focus (EDOF) products, the IC-8 IOL and LuxSmart (Bausch and Lomb).

Following a presentation by Dr Damien Gatinel from Rothschild Foundation Hospital in Paris, France, on the key mechanisms employed in EDOF IOLs today (with refraction and diffraction being the key players), attention turned to Dr Karl Stonecipher.

THE IC-8 IOL

A Clinical Professor of Ophthalmology at the University of North Carolina, and Clinical Adjunct Professor of Ophthalmology at Tulane University, Dr Stonecipher evaluated subjective and objective visual quality results achieved with the IC-8 IOL.

Describing this extended depth of focus lens design as “a brilliant lens… that really gives a true range of vision”, he explained that “the small aperture design filters out unfocussed and aberrated peripheral light that degrades image quality, allowing only central light rays to focus on the retina”.

Having been among the first in the United States to trial the lens, Dr Stonecipher is currently the number one implanter of the IC-8 in his country. He has used it on and off label, and every one of his IC-8 patients, except one, has had the lens implanted bilaterally.

Dr Stonecipher reported on a US clinical trial, which enrolled patients in one of two groups:

• The IC-8 group (n=343) received a monofocal or monofocal toric IOL in the fellow eye, targeted to plano and an IC-8 small aperture IOL in their study eye, targeted to -0.75.

• The control group (N=110) received bilateral monofocal or monofocal toric IOLs targeted to plano in both eyes.

The study reported outcomes at six months post-op on binocular photopic and mesopic contrast sensitivity and subjective patient visual symptoms.

It found that the IC-8 IOL group achieved monofocal-like binocular photopic and mesopic contrast sensitivity, with patients reporting very low-level visual symptoms post-operatively in both the IC-8 IOL and control groups.

At 12 months, of 331 patients, only 3.0%, 3.6% and 3.6% respectively, reported experiencing severe glare, halos and star bursts. There were no problems reported with moving from bright light and into dim light (or vice versa) when compared with the control group. He said uncorrected visual acuities in the fellow eye performed “a touch better” but not significantly so.

Despite being a monovision IOL he said this “modernised monovision” lens design provides useful vision for 85–90% of tasks.

“The IC-8 is such a win over the standard monofocal – Idon’t even offer a standard monofocal anymore,” Dr Stonecipher said. He added that the benefits of a premium IOL far outweigh additional costs, in terms of quality of vision and lowering the risk of falls etc.

LUXSMART IOL

 Dr Paul Athanasiov spoke about the LuxSmart IOL, describing it as an extended range of vision intraocular lens with some “really fancy optics” that achieved predictable outcomes. Based on a combination of 4th and 6th order Spherical Aberration of opposite signs, this hydrophobic one-piece preloaded IOL has four-point fixation and ultraviolet and violet light filters.

A proclaimed agnostic when it comes to choosing IOLs, Dr Athanasiov said he uses “pretty much any lens” he wants to use, depending on the patient.

As the first surgeon in Australia to use LuxSmart toric and non-toric IOLs, he said he started implanting them more than a year ago because of unmet need, putting them in all candidates for a distance or an EDOF lens, except those with severe dry eyes or myopia, or those who desired complete spectacle independence.

Dr Athanasiov noted that demand for functional intermediate and near vision has increased among seniors, particularly since COVID, because of their use of digital technology.

Specifically, the number of seniors with internet at home has grown from 68% to 93% and the number and type of digital devices that seniors use – for keeping in touch, shopping, entertainment, and managing personal affairs – has also increased.1

Speaking of 268 eyes he has implanted with LuxSmart (40% of them with toric IOLs) he said the majority have achieved 6/6 binocular uncorrected distance visual acuity (BUDVA) with excellent intermediate and functional nearby. Additionally, while this is not a near vision lens, a lot of patients were able to read unaided.

A post op assessment and questionnaire completed by 56 patients he implanted between May 2022 and May 2023 assessed patient satisfaction with binocular uncorrected distance, intermediate, and near vision, finding:

• Binocular uncorrected distance vision: 92.9% achieved 6/7.5 or better; 100% achieved ≤ 6/12.

• Binocular uncorrected intermediate vision (BUIVA): 98.0% achieved N6 or better, with 100% achieving N8 or better.

• Binocular uncorrected near vision (BUNVA): 88.2% achieved N8 or better with 98.0% achieving N10 or better.

• 100% of patients responded “Yes” to the questions: “Are you satisfied with the treatment result?”, “Would you recommend the treatment to a friend or relative?”, and “If given the choice, would you select the same treatment?”.

When rating their vision without glasses he reported that the average scores were: 9.3/10 for physical or leisure activities (such as walking, playing sports, cooking, or shopping); 9.2/10 for watching movies or sports, 8.4/10 for using a computer, and 7.4/10 for using a tablet or smartphone.

When discussing vision requirements with patients, Dr Athanasiov noted that rather than referring to near, intermediate, and distance vision, it is more useful to provide real life examples of what they might do with the different levels of vision that can be achieved with alternate lenses. This creates more realistic expectations.

Reference 1. Australian Communications and Media Authority. Communications and media in Australia. The digital lives of older Australians, May 2021.