Ophthalmologists from Australia, Taiwan, Singapore, Indonesia, Philippines and India came together at the Asia Pacific Academy of Ophthalmology Congress (APAO) in Bali to discuss the use of Rayner’s RayOne enhanced monovision (EMV) intraocular lens (IOL) for optimising visual outcomes.
Hosted by an always-entertaining Dr Ben La Hood from Adelaide, the evening enabled ophthalmologists to share experiences and debate their opinions in an informal environment.
Professor Tun Kuan Yeo from Singapore presented his experience and clinical outcomes with the EMV IOL, which was designed by Australia’s Professor Graham Barrett to give greater depth of focus than a monofocal IOL but with a similar low level of visual side effects.
Describing it as “a great preloaded hydrophilic IOL” he set the tone by stating “if you’ve tried it, you’ll know it works very well”. He said the main concept is that you have control of positive spherical aberrations.
“The difference is being in control of spherical aberration to give depth of focus but at the same time it doesn’t degrade your quality of vision,” he said.
His patient studies have shown that the EMV IOL works well when implanted both unilaterally and binocularly. He showed monocular defocus curves in both mesopic and photopic environments, demonstrating that the lens works in both light and dark, to provide great vision quality with a natural range of vision and observed “amazing results targeting monovision”.
Similarly, he said binocular bilateral emmetropia mesopic and photopic defocus curves also showed the lens works well in light and dark.
Catquest questionnaires on his outcomes comparing bilateral emmetropia (BE) and modest monovision (MM) patients found: Fairly or very satisfied with outcomes: BE:78% and MM: 90%; reading television subtitles: around 90% for both groups; reading text and newspapers: BE 60%; MM 90%; and reading labels on the back of goods: 60% BE; 100% MM. Summarising he said, “It’s a lifestyle lens – if you have no great demands for near work you can aim for bilateral emmetropia and if you do need some near work you can aim for modest monovision.
Dr Tsui-Kang Hau from Taiwan presented tips and tricks for presbyopia correction with IOLs. He said presbyopia correction involves a balance of compromises. “When you increase the depth of focus then your visual quality can potentially be decreased a little bit… we need to find the balance”. Dr Tsui-Kang recommended surgeons correct lower order aberrations first, correcting sphere and cylinder appropriately; measure the patient’s pupil size and know how it will influence spherical aberration; and use a modern IOL calculation method.
Dr Lourens van Zyl from Western Australia, drilled into why managing spherical aberration is the best option for obtaining spectacle independence. He said spherical aberration is the only optical phenomena the human brain has evolved to adapt to. As a natural phenomenon we all live with it can be safely harnessed to achieve spectacle independence without losing contrast sensitivity. He said surgeons know diffractive lenses “can be quite toxic for patients, so we should be thankful for ophthalmologists like Graham Barrett and Dan Reinstein… who have brought spherical aberrations to the fore”. His favourite techniques for providing spectacle independence, the Presbyond laser vision correction option for presbyopes, and the RayOne EMV IOL, are both based on managing spherical aberrations and appear to provide excellent outcomes with minimal side effects.
Stating that the RayOne EMV has become his standard lens, Dr Lourens van Zyl said aiming for emmetropia with EMV lenses gives patients excellent intermediate vision and relatively good functional near vision. He also does “a mini blend for patients who put a premium on intermediate vision”. For patients who are adamant they want to read without their glasses he tells them “after the age of 45 there is no such thing as complete spectacle freedom… even with multifocal lenses there may be times such as dim lighting or extremely fine print where everyone still needs a boost”. It is important to set realistic expectations for patients.
Dr Brian Harrisberg from Sydney spoke about meeting the visual requirements for sports people, specifically golfers. He said when golfers ask “when he will fix their eyes”… “the answer is not simple” as they need excellent distance and near vision as well as intermediate vision. “Golfers are extremely obsessed about where the golf ball goes but they also want to read their score card… all in both high contrast and low contrast conditions.”
When optimising vision for golfers with the RayOne EMV he said he always targets the dominant eye first with a plus and the non-dominant eye with a low minus power. “The RayOne EMV is so good for sport because we’re not filtering light, it enhances daylight vision, there is minimal disturbance in contrast sensitivity, and there are no discernible aberrations,” he said.
Dr Cyres Mehta from India also spoke about using EMV for demanding patients including hairdressers and sports people. As a professional athlete he realises the need to see at different distances and said the EMV has enhanced his ability to provide even the toughest patients with a great visual result.
Meanwhile, Dr Victor Caparas from the Philippines spoke about the benefits of implementing RayPRO (Rayner’s patient reported outcome measures platform), and Dr Amir Shidik from Indonesia presented on the Sophi phaco system that was recently acquired by Rayner.
Concluding, Dr LaHood said all the speakers agreed the EMV was a game changer, enabling them to maintain excellent vision while giving some depth of focus. “This is a feature that has been missing from some IOL designs where depth of focus has been provided but at the cost of vision quality”.
