Growth in premium IOLs represents opportunity for ophthalmology

The so-called premium channel for IOL implants includes presbyopia-correcting IOLs, toric monofocal IOLs and toric presbyopia-correcting IOLs. With the recent approval of the Abbott Symfony IOL, we now have three categories of presbyopia-correcting IOLs: multifocal, accommodating and extended depth of focus. While each of these IOL categories is commonly used for symmetrical bilateral implantation, the lenses can also be custom mixed with one style implant in one eye and another in the fellow eye. There are many multifocal IOLs approved in the U.S., with adds ranging from a low of +2.5 D to a high of +4 D. Most surgeons are finding the lower add multifocals between +2.5 D to +3.25 D to be preferred by patients because they provide better intermediate vision and cause less night vision disturbances such as glare, starburst and halo.The multifocals approved in the U.S. all use diffractive optics and in reality are bifocals, with two zones of focus. In Europe and many Asian countries, trifocal diffractive multifocal IOLs with three overlapping zones of focus have replaced bifocal diffractive multifocal IOLs. Surgeons and patients find a more seamless range of vision from far to near with these trifocal IOLs, with similar reduced contrast and night vision symptoms as that found in bifocal IOLs. Unfortunately, we do not have a trifocal or even toric bifocal multifocal IOL approved in the U.S. as yet, limiting intraoperative astigmatism management to corneal relaxing incisions and primary incision construction and placement.