Which IOL Will You Choose in 2005?

By David F. Chang, MD, Chief Medical Editor

Before 1994 (the year the Acrysof IOL was FDA-approved), IOL choices were fairly simple. Surgeons who performed manual extracapsular cataract extractions implanted large-optic PMMA IOLs, and those who practiced phacoemulsification usually selected either a foldable silicone IOL or a truncated, oval PMMA lens. Although the ensuing innovations in and evolution of IOL design have produced enormous benefits for surgeons and their patients, this remarkable progress has come at the expense of simplicity. Gone are the days when we merely chose a primary IOL model to implant in all patients. Now, we must individualize IOL selection depending on a host of patient variables.

During the past 10 years, much of the focus of IOL research has centered on determining the best IOL material and the best haptic and edge configurations. In terms of biocompatibility, both hydrophobic acrylic and second-generation silicone have emerged as superior materials. Combining truncated optic edges with these two materials has dramatically reduced the incidence of posterior capsular opacification. Thanks to the latest generation of IOL injectors, virtually all foldable IOLs can currently pass through sutureless, sub-3.5-mm incisions.

Now that these questions have largely been settled by evidence-based studies, new IOL technology is proceeding in two important directions that both relate to optics. One set of innovations seeks to expand refractive benefits (eg, toric IOLs, minus- or low-plus-powered IOLs, and presbyopia-reducing IOLs). Indeed, once the Restor multifocal IOL (Alcon Laboratories, Inc.) is released, US patients averse to reading glasses will have four IOL options from which to choose: an accommodating IOL, two multifocal designs, and pseudophakic monovision.

Appropriately, the other important frontier of IOL technology is pseudophakic contrast sensitivity. Such analysis is necessary to better understand the potential advantages of aspheric lenses such as the Tecnis IOL (Advanced Medical Optics, Inc.) and the potential drawbacks of multifocal and blue-blocking optics. With so many creative new IOL designs, evaluating the optimal balance between optical benefits and tradeoffs should be our next priority. Interestingly, major IOL concerns of the past decade—posterior capsular opacification, inflammation, centration, and incision size—were quickly assessable at the slit lamp. We will need different tools to better understand contrast sensitivity, IOL-related dysphotopsias, pseudo- or true accommodation, and ultimately overall quality of vision.

Although futuristic IOL concepts continue to pique our curiosity, this issue of Cataract & Refractive Surgery Today focuses on a more immediate and practical question: which pseudophakic IOL to choose in 2005? The following pages highlight six options that are either relatively new or are expected to debut this year. To debate their merits, we convened a panel of experts to share their experiences in a roundtable discussion that was not commercially sponsored. As you will see, there is no clear consensus. However, we hope that this issue will stimulate you to formulate new questions and opinions of your own.

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Which IOL Will You Choose in 2005?

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