In a world where seniors are living longer, more active lives, one thing remains crystal clear – they want to see well. Alcon’s Eye to Eye – Elevating Presbyopia Correction session at the 41st Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2023) shed light on the changing landscape of vision care for the elderly, focusing on the advancements in cataract surgery and presbyopia-correcting IOLs. Experts Dr. Ike Ahmed, Dr. Chandra Bala, Dr. Giacomo Savini, and moderator Mr. Arthur Cummings gathered to discuss the latest developments.
Healthy aging for an active population
Mr. Cummings kicked things off by addressing the evolving expectations of seniors in today’s society. He noted that older adults are more active than ever and increasingly prioritize their vision as they age.
“Today’s 70-year-old is very different from a 70-year-old 40 years ago, so vision is among the most important aspects of aging, alongside mobility and memory,” Mr. Cummings said.
Alcon Eye on Cataract survey, recently surveyed over 7,000 people, found that 83% of respondents consider vision to be a critical factor of aging, only behind memory. In addition, 3 in 4 people surveyed said everyday activities are what they look forward to enjoying post-cataract surgery. 83% of those surveyed wanted to read as before, 80% sought to use digital devices, and 74% deemed driving important.1 These findings underscored the significance of near vision in the lives of active seniors.
“I think it’s even beyond what we call near vision,” Dr. Ahmed said. “You know we can divide near vision into reading and intermediate, and I see more and more folks keen on enhancing their intermediate vision for iPad use, maybe cellphone use. Unfortunately, myself included, people are reading fewer books and less small print. You know our lifestyle evolution has clearly changed over the last decade.”
Meeting evolving expectations
The surgeons discussed the role of modern cataract surgery and IOLs in meeting the evolving expectations of senior patients. Dr. Bala emphasized the importance of personalized solutions for complex cases. “There is a particular lens for a particular person,” he noted. Factors such as refractive history, ocular conditions, and patient expectations play a pivotal role in the selection of IOLs.
Dr. Bala highlighted two remarkable Alcon lenses that are revolutionizing the landscape of vision correction: AcrySof IQ Vivity® (Vivity) and PanOptix® Trifocal. These lenses offer more benefits to patients, considering their diverse needs. In two cases presented, he opted for the Vivity for one because its more forgiving and flexible defocus curve delivers confidence in hitting a refractive target. Vivity IOL allows surgeons to regularly offer the benefits of presbyopia correction to patients, especially those who are not suitable for trifocal IOLs. PanOptix trifocal for the other patient, a semi-professional snooker player, who wanted a full range of vision from near to far to play snooker.
Case 1: Far, far away2
The first patient was a senior refractive surgeon who had known about her cataracts for some time. She previously had LASIK surgery for myopia but felt forced into monovision, which she didn’t like. She has -2.75 of astigmatism, which is unexpected after LASIK. Corneal topography showed irregularities and higher-order aberrations suggested instability, possibly due to dry eye.
“This suggests that this eye is not stable. It’s not perfect. The dry eye component is something that’s affecting the metrics,” Dr. Bala explained.
The dilemma was whether to proceed with surgery and deciding which IOL to use, its power, and axis.
“So, I do an IOL master. It says put a 21 diopter lens, T2, at 168 degrees, and you will get -0.1. I know she doesn’t like -0.1. She wants distance as much as possible,” Dr. Bala continued. “But the decision has to be made. Do I put a T2 and at what axis? Do I believe the IOL master? Do I believe the Pentacam? Do I believe the Orbscan? I am now in paralysis by analysis.”
The decision is made to prioritize distance vision and use intraoperative aberrometry to guide IOL selection, resulting in a successful outcome with the Vivity lens. The audience agreed with Dr. Bala’s choice.
“I went with Vivity largely because I need a landing zone,” Dr. Bala said. The Vivity has a broad landing zone hence if the patient is a little bit on the plus side or a little bit on the minus side, the surgeon is still going to land on an excellent quality distance visual acuity. “I understand there is higher order aberration. I understand there is asphericity. I understand there are toric issues, but fundamentally, if I need to have a good outcome, I need my sphere right.”
As for the patient who cared mostly about distance? “She’s wearing a + 1 for a piano and +2 for reading and she’s very happy,” Dr. Bala said.
Case 2: I want everything2
The second patient was a 64-year-old semi-professional snooker player who realized he couldn’t see in his right eye when he closed his left eye. He wore glasses for reading and had a myopic prescription of -2.75. He wanted a wide range of vision for snooker, from near to far, but his corneal topography showed issues in the right eye. While he may be left-eye dominant, he didn’t use his right eye much. Higher-order aberrations were at 0.7.
The challenge was to address his vision needs and decide on the appropriate treatment, potentially considering options like multifocal or accommodating IOLs. Dr. Bala used the T2 PanOptix (trifocal) in this case. The audience supported the choice, with 54% voting to opt for Trifocal (PanOptix) for both eyes for this patient. The patient now has a 6/6 vision; he is happy, and he can read and can read at 5, so he has decided to defer his other eye surgery.
In Dr. Bala’s practice, Vivity grew from 7% in 2020 to 66% in 2023, mainly due to a monofocal IOL drop. The same is true of most surgeons in Australia, who flipped towards Vivity.
Vivity IOL: The balance of clarity and extended-depth-of-focus
Designed to strike a perfect balance between extended-depth-of-focus (EDoF) and excellent visual acuity, Vivity provides patients with clear visual acuity across varying distances. This innovative lens minimizes the potential for visual disturbances, a critical consideration for patients seeking optimal vision.
Dr. Ahmed pointed out that technology has made modern IOLs more forgiving and precise. This advancement allows surgeons to use these lenses in a larger range of patients, opening up possibilities for those who may not have been candidates for trifocal lenses in the past.
“I think increasingly it’s important to understand and be comfortable with these lenses,” he said. “Patients would want to go to surgeons who are well aware of the options.
“Patients also are increasingly informed about their options, and many are willing to invest in technology that can reduce or eliminate their dependence on glasses,” Dr. Ahmed said.
Mr. Cummings added that often (surgeons) incorrectly assess the patient’s willingness to pay. “We make those judgments, but it’s not our judgment to make. Hearing aids cost four times what these IOLs do, and these IOLs remain in your eye for life; they’re not exchanged every four years, so cost is relative.” Survey Data shows that 3 in 4 patients agree they are willing to pay for a lens that is likely to eliminate the need for glasses after surgery.1
The increasing acceptance of presbyopia-correcting IOLs
The session also addressed the growing acceptance of presbyopia-correcting IOLs (PCIOLs) among both patients and surgeons. As the panel discussed, the perception of these lenses has shifted dramatically over the years.
Dr. Bala highlighted the changing mindset among surgeons, particularly new graduates, who are more open to incorporating presbyopia-correcting IOLs into their practice. Technology has made these lenses more accessible and precise.
“In 2021, there was a survey done, and 66% of doctors wanted to put in an EDoF lens in the next five years3,” Dr. Bala said. “And I think that number is going to shift further and further.
Personalized solutions for complex cases
The panel emphasized the importance of personalized solutions for complex cases. Each patient presents a unique set of challenges and requirements, and selecting the right IOL is crucial for their visual satisfaction.
Mr. Cummings noted that even practices with a high volume of monofocal cataract surgeries should consider presbyopia-correcting IOLs for their patients. The goal is to provide patients with the opportunity to consider these lenses, ensuring that they are well-informed about their options.
“The biggest point is whether or not you have a very high-end practice, there are always patients in our practices that are candidates for these lenses, and I think that’s important for us to note,” he said.
Dr. Ahmed added, “Particularly for new graduates, the mindset has changed; the other phenomenon we are seeing is that the barrier to entry (for new graduates) has reduced with newer IOLS, making it easier for surgeons to jump in. These lenses are easy to use, more forgiving, can be used in a broader range of patients, and technology allows them to be more precise.”
Elevating Presbyopia Correction with AcrySof IQ Vivity®
- AcrySof IQ Vivity®: A presbyopia-correcting IOL with X-WAVE™ technology and a proven low rate of visual disturbances.4-7
- Simplifying presbyopia correction: Vivity offers extended vision and simplifies the presbyopia-correcting experience for surgeons and patients while delivering monofocal-like certainty.4-10
- Expanding candidate pool: Vivity broadens options for patients who were previously excluded from multifocal IOLs.11
- Superior halo profile: Vivity stands out among diffractive EDoF lenses, providing excellent vision with minimal glare and halos. 6,7,11
- High satisfaction: 9 in 10 patients are highly satisfied and would recommend it to others.12
Editor’s Note: The 41st ESCRS Congress was held in Vienna, Austria, from 8-12 September 2023. Reporting for this story took place during the event.
- Cataract Research Survey 2023 – Global Survey Report
- 2023 Alcon Inc. 9/23 EMEA-VIV-2300020
- ESCRS Clinical Trends Survey 2021 Results (Page 6). Available at: https://www.escrs.org/media/s5dlnraf/2021_escrs_clinical_survey_supplement.pdf Accessed on 26 September 2023.
- AcrySof IQ Vivity® Extended Vision IOL Directions for Use
- Alcon Data on File, US Patent 9968440 B2, May 15, 2018
- Bala C, Poyales F, Guarro M, et al. Multicountry clinical outcomes of a new nondiffractive presbyopia-correcting IOL. J Cataract Refract Surg. 2022;48(2):136-143.
- McCabe C, Berdahl J, Reiser H, et al. Clinical outcomes in a U.S. registration study of a new EDOF intraocular lens with a non-diffractive design. J Cataract Refract Surg. 2022;48(11):1297-1304.
- Baur ID, Auffath GU, Yan W, Labuz G, Khoramnia R. Visualization of Ray Propagation through Extended Depth-of-Focus Intraocular Lenses. Diagnostics (Basel). 2022;12(11):2667.
- Ligabue E, et al. ACRYSOF IQ VIVITY: Natural vision at a range of distances provided by a novel optical technology. Cataract & Refractive Surgery Today. April 2020.
- Ahmed IK, et al. The Vivity Extended Depth of Focus IOL: Our Clinical Experience. Cataract & Refractive Surgery Today. February 2021. Available at: https://crstoday.com/wp-content/uploads/sites/4/2021/02/0221CRST_Alcon-Vivity-2_ROB.pdf Accessed on 25 October 2023
- Kohnen T, Berdahl JP, Hong X, Bala C. The Novel Optical Design and Clinical Classification of a Wavefront-Shaping Presbyopia-Correcting Intraocular Lens. Clin Ophthalmol. 2023:17:2449-2457
- Reus NJ, Kooijman M, Perez-Vives C. Overall Visual Outcomes from a Real-world Study of Presbyopia-correcting IOLs in a Large Population. Presented at the European Society of Cataract and Refractive Surgery (ESCRS) Annual Meeting; 8-12 Sept, 2023; Vienna, Austria.