Today’s ageing population is redefining what it means to lead an “active” lifestyle even in their twilight years. Gone are the days when retirement automatically signalled a slow-paced, sedentary chapter. Instead, many seniors are focused on continuing work well beyond the standard retirement age. As a result, high-quality vision has become paramount for today’s ageing adults to fully participate in the myriad aspects of modern life. A vision problem such as cataracts can significantly impede the vision and the active lifestyle of ageing adults. But with advancements in Inter-Ocular Lenses (IOLs), we can give these active ageing adults the lifestyle they desire. Now there is an array of IOL options such as toric, trifocal and EDOF to address the unique needs of patients.
Multifocal or bifocal IOLs were early solutions to reduce dependence on glasses after cataract surgery by providing two separate focal points – one for distance vision and one for near vision. Patients, however, experienced visual disturbances like glare and halos around light sources and reduced contrast sensitivity (1). Trifocal IOLs are an enhancement of the multifocal design in which the light splits to provide multiple focus points. Their goal is to close the intermediate gap by integrating a third focal point tailored for intermediate use (1).
Toric IOLs allow patients with astigmatism to enjoy distortion-free vision (2). They have been used to correct regular corneal astigmatism since 1992, but have undergone several improvements since then (3). Recent studies show that the indications of toric IOLs can be expanded beyond regular corneal astigmatism (4). They have been used to effectively correct certain types of irregular corneal astigmatism also (4). The advanced toric IOLs are also presbyopia-correcting and provide patients with reduced dependence on glasses even for near vision (5).
The newest IOL, EDOF (extended depth of focus) offers an optimal solution for intermediate and distant vision with minimal visual aberrations (6). It gently bends light in such a way that enhances the depth of focus while maintaining high image quality across all distances (6). These IOLs enable clear vision at 30-40 inches, which is critical for computer work (6). They provide unmatched convenience and autonomy for older adults embracing the digital world and who choose to remain active with jobs that require prolonged screen time. EDOF IOL provides a seamless transition between working on screens and routine activities. The intrinsic simplicity of the EDOF lens reduces visual disturbances and side effects like glare, halos and starbursting around lights (6). This contrast sensitivity makes viewing bright screens more comfortable – an important benefit given the excessive screen usage of many older adults.
The IOL selection is an art as much as it is a scientific process. It requires an in-depth assessment of patient-specific ocular characteristics, the presence of corneal astigmatism and the health of the ocular surface. These factors need to be combined with the patient’s visual goals, lifestyle and personality. This holistic approach helps us achieve optimal surgical outcomes and meet the expectations of patients.
References
- Zhang, Z., Jiang, H., Zhou, H., & Zhou, F. (2021). Comparative Efficacy Between Trifocal and Bifocal Intraocular Lens Among Patients Undergoing Cataract Surgery: A Systematic Review and Meta-Analysis. Frontiers in medicine, 8, 647268. https://doi.org/10.3389/fmed.2021.647268
- Singh, Vivek, Muralidhar R., Murthy, S, Rostov, A.T. (2022) Toric intraocular lenses: Expanding indications and preoperative and surgical considerations to improve outcomes. Indian Journal of Ophthalmology 70(1):p 10-. | DOI: 10.4103/ijo.IJO_1785_21
- Mohankumar A, Mohan S. (2023), Toric Intraocular Lenses, National Library of Medicine, https://www.ncbi.nlm.nih.gov/books/NBK592396/
- Chen, X., Jiang, Y., Gao, N. (2024) Effectiveness of toric intraocular lens implantation for correcting irregular corneal astigmatism in cataract eyes. Sci Rep 14, 8868. https://doi.org/10.1038/s41598-024-59303-0
- Bissen-Miyajima H, Ota Y, Yaguchi S, Nakamura K, Sasaki N. Clinical Results of a Trifocal Toric Intraocular Lens Using the Holladay Total Surgically Induced Astigmatism Formula for Correcting Low Corneal Astigmatism in Japanese Patients. Clin Ophthalmol. 2024;18:755-763https://doi.org/10.2147/OPTH.S448427
- Megiddo-Barnir, Elinor MD*; Alió, Jorge L. MD, PhD*,†. Latest Development in Extended Depth-of-Focus Intraocular Lenses: An Update. Asia-Pacific Journal of Ophthalmology 12(1):p 58-79, January/February 2023. | DOI: 10.1097/APO.0000000000000590