Best Monofocal Lens

[Hoddy44]

Although Dr will talk about differences in multifocals, they seem to stick with certain monofocals and do not talk about differences between them. For a highly farsighted individual with small pupils, does it really make any differences whether I choose spherical or aspherical or which aspherical I choose. I have a Dr familiar with Tecnis monofocal.

[Forum-OD-MP]

this is like asking "whats the best car?"  many, many different opinions on this.

depends on the rx/patient/eye/surgeon/etc etc

[JodieJ]

The current issue of Eye World Magazine--August '06 (www.eyeworld.com) has some very interesting articles about aspheric lenses (as well as multifocal IOL mixing related to pupil size).  It's worth skimming the back issues, too.

Re aspherics, there's a tradeoff between sharp distance vision vs. good intermediate/near vision.  Aspheric IOLs improve contrast sensitivity/distance vision, but near and intermediate vision are not as good as with a conventional lens.  One  article even states that reading glasses are mandatory for satisfactory intermediate vision with an aspheric IOL.  (I plan on wearing multifocal contacts post-surgery, so this isn't important to me.)  Aspheric lenses require precise centration and are reported to work better with larger pupils.

Which of the three aspherics works best seems to depend on which manufacturer is funding a particular study.  I'd be inclined to choose the Tecnis lens because it corrects the most spherical aberration.  However, the Tecnis surgeon I consulted wanted me to postpone surgery until my vision had deteriorated to a level at which my driver's license could be revoked.  (Forget that!)  So I'm going with the Alcon AcrySof IQ and surgery in September.  I'm not too happy with Alcon lenses' blue-blocking property (also a feature of ReStor), but at the power I need the IOL's ability to block blue light will substantially reduced.  

[JodieJ]

Whoops--the website address for Eye World Magazine is www.eyeworld.org (incorrectly sited above.)

[eyecu]

I am not sure with your discussion about ashperics and multifocals. Multifocals provide near intermediate and distance with the ReZoom and near and distance with the ReStor. Conventional spherical IOL's provide distance vision and aspherics provide distance with improved contrast especially in low light. The Tecnis is the original and has the studies to back it. The others do not. Blue blockers can cut contrast. There is a lot more to it. Sounds like your first doc just wants you to wait. It's your call but the Tecnis offers the most for you if you are not a multifocal candidate.

[JodieJ]

The Tecnis lens would be my first choice, and my surgeon is willing to implant it, but apparently the SURGICENTER won't allow it.  I don't understand those politics at all.

I have a research background, and I actually reviewed the studies concerning the costs/benefits of blue light filtration.  I concluded that there's probably not a meaninful cost or benefit, especially in the power of the lens I need.  (The ability of an IOL to block blue light varies with its power.)  Hud naturally disagrees with me about this.

[hud]

no, I disagree with your terminology. If lenses block blue light, you would not see gas flames, the blue sky, etc. The chromophore is a filter with the average spherical power of 21 diopters approximating the natural human lens filtration of a 25 year-old. The highest power of Alcon lens available for hyperopes, +30 diopters, equates to the retinal protection of a 53 year old crytalline lens.  Also, more patients are being implanted with Alcon's blue filtered lenses than all others combined. Don't get too hung up on this, as AMO and B&L are both pursuing blue filters as fast as they can.
Recent submissions to Medicare have shown that Alcon's IQ aspheric lens with the blue filter outperformed AMO's clear Tecnis lens in nightime driving study. This lens was then awarded New Technology Intraocular Lens status, granting extra reimbursement to surgery centers that use it. Hardly a reason to question contrast sensitivity. Go to the skeet range and see the yellow shooting glasses that they wear for improved contrast vision.

[eyecu]

The Tecnis lens is the leader in aspheric IOL's and was the first with the most studies and data. The IQ is the follower. Hud is who is so big on studies for the ReStor needs to come forward with the studies on the IQ which was called the WF first and than the name changed. Why? More are implanted, so what. More people drive Chevy's than Lexus and Mercedes. I see no point. Ask the optics experts like Dr. Holladay etc.. The Tecnis mimics the vision of a 19 year old and the WF IQ that of about a 40 year old. Which do you want? The IQ is trying to ride on the wings of the Tecnis but it has already flown away. Results speak for themselves.

[hud]

Dear Car salesman:
I report what I research from the companies themselves. You can get the data too, to see who is peddling chevys and mercedes. Being first is sometimes good. AMO silicone was first as a foldable-small incision IOL. They enjoyed 100% marketshare for years until Alcon turned the market upside down with AcrySof. AMO now runs at about 24%.Alcon's IQ and Natural blue filtering IOLs now dominate the industry despite having the highest ASP. Tecnis is a great product, and Pharmacia/Pfizer did the heavy lifting to create the NTIOL category that other manufacturers can now apply for, but they have to MEET OR EXCEED the performance of Tecnis to qualify. AMO took Pfizer's silicone platform and now offers it at a higher price on an acrylic platform (AcrySof envy?). The Array silicone is discontinued in favor of the acrylic Rezoom (notice a pattern?). Paid consultants like Jack Holliday and Warren Hill will be splitting hairs over spherical aberrations till the cows come home. The fact remains that AMO will forever be stuck with the 40 year-old multipiece sulcus design because their acrylic will never be able to be manufactured in an elegant one-piece design such as the AcrySof. At least they are coming around with work on adding more retinal protection. I have spoken with about 15 surgeons around the country, and if price is not an issue, 90% prefer Alcon IOL's. It is where the doctors have an interest in the surgery center's profits, do they "settle" for another brand. AMO has great management, so I expect Jim Mazzo to keep it interesting.

[JodieJ]

Hey, guys, both Alcon and AMO make excellent lenses.  But the field of cataract/IOL is not exactly consumer friendly, which makes it hard for us patients to know what would be best for OUR eyes. The professional literature doesn't provide much guidance in this regard, since just about all the authors are paid consultants.  And in my town, most of the surgeons work with only one manufacturer's lenses.  Plus, for the record, I'd really like to know how a surgery center gets away with dictating which lenses a doctor is allowed to implant.  All of the above conditions make it harder for consumers to make the best choice about their vision.

Maybe it's the case that there's little difference between Tecnis vs. AcrySof IQ.  But there do seem to be distinct advantages/disadvantages associated with each the multifocals.  There's an interesting article in the current Eye World ("What We Can Learn from Presbyopic-Correcting IOLs") about the great results obtained in Brazil from mixing multifocal IOLs (including the Tecnis MF).  From the consumer's point of view, it would really be helpful if the manufacturers could view each other as potential collaborators.  With all of us aging baby boomers, there should be plenty of pie for everybody.