6 Major Advances in Ophthalmology

Innovation is defined as the introduction of something new. Ophthalmology and its subspecialties have been at the forefront of medical innovation and have embraced the rapid advances in various technologies, including pharmacology, imaging, data processing, and devices. The year 2016 was no exception. Although the origins of many of these advances began earlier, this year saw them begin to take hold by ophthalmologists and other eye care professionals, with the ultimate goal of improving the quality of life for our patients.

A New Intraocular Lens

Technological advancements in multifocal intraocular lens (IOL) design have been made with the goal of improving both optical quality as well as the patient's range of vision. Patients desire the ability to retain spectacle independence, even after cataract surgery. Even though early versions of the multifocal intraocular lens allowed improved vision at both distance and near, unwanted optical side effects included glare and halos, particularly at night. Careful patient selection and accurate biometry were needed to improve patient satisfaction with these lenses.

Over the past decade, IOL technology has moved from refractive technology to diffractive technology with apodization, resulting in less frequent and less intense visual side effects. Apodization improves image quality by optimizing the focus of light by distributing the appropriate amounts of light to near and distant focal points regardless of the lighting situation. Mechanically, apodization is accomplished by recontouring the "shoulders" or edges of the multifocal steps of the IOL. The net effect results in improved overall vision quality with a reduction in dependence on pupil size and lighting compared with earlier technologies. Besides the diffractive technology with apodization, use of aspheric lenses has improved spherical aberration. Inherent to the human eye is an average of approximately 27 µm of spherical aberration.

In July 2016, the US Food and Drug Administration (FDA) approved an achromatic Tecnis Symfony® IOL (Abbott Medical Optics, Inc; Santa Ana, California), the first "extended depth of focus" (EDOF) IOL to be available in the United States. This IOL is believed to be a game changer. The IOL has a diffractive step-like optic profile that is intended to provide extended range of vision while correcting chromatic aberrations for contrast sensitivity enhancement using proprietary technology.^[1] Because diffractive optics may reduce contrast, the introduction of reduced chromatic aberration counterbalances the reduced contrast from diffractive optics, resulting in 20/20 vision even in suboptimal lighting conditions.

This IOL is believed to be a game changer.

In one study that compared optical quality, contrast sensitivity, and quality of life, the achromatic IOL was found to have outcomes similar to those of an aspheric monofocal IOL.^[2]

An added benefit of the Symfony EDOF IOL is that it is currently available as a toric lens, meeting the needs of patients with significant astigmatism. This is the first lens available in the United States that combines toric with EDOF technology.

The introduction of EDOF technology will have a positive impact on the already largely successful outcomes seen in cataract surgery, providing additional options and also greater patient satisfaction due to improved quality and range of vision.

Authors and Disclosures

Authors

Ronald C. Gentile, MD

Professor, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai; Surgeon Director, Director, Ocular Trauma Service (Posterior Segment), New York Eye and Ear Infirmary of Mount Sinai, New York City

Disclosure: Ronald C. Gentile, MD, has disclosed no relevant financial relationships.

Brooke Nesmith, MD

Second Year Retina Fellow, New York Eye and Ear Infirmary of Mount Sinai, New York, New York

Disclosure: Brooke Nesmith, MD, has disclosed no relevant financial relationships.

Kenneth J. Rosenthal, MD

Associate Professor of Ophthalmology, University of Utah Medical School, Salt Lake City, Utah; Surgeon Director, Rosenthal Eye Surgery, Great Neck, New York

Disclosure: Kenneth J. Rosenthal, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Abbott Medical Optics, Inc.; Bausch & Lomb Inc.
Serve(d) as a speaker or a member of a speakers bureau for: Abbott Medical Optics, Inc.; Bausch & Lomb Inc.

Richard B. Rosen, MD

Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai; Vice Chair and Director of Ophthalmology Research; Director and Chief, Retinal Services, New York Eye and Ear Infirmary of Mount Sinai, New York, New York

Disclosure: Richard B. Rosen, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Optovue, Inc; Clarity Medical Systems, Inc.; Allergan, Inc.; Genentech, Inc.; Carl Zeiss AG; Regeneron Pharmaceuticals, Inc.; Nano Retina; OD-OS
Serve(d) as a speaker or member of a speakers bureau for: Optovue, Inc; OD-OS; Regeneron Pharmaceuticals, Inc.
Received research grant from: Genentech, Inc.; Optovue, Inc; Nano Retina
Have a 5% or greater equity interest in: Opticology

Emily C. Waisbren, MD

Assistant Professor, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai; Staff Physician, Department of Ophthalmology, Cornea Service, Mount Sinai Hospital, New York, New York

Disclosure: Emily C. Waisbren, MD, has disclosed no relevant financial relationships.

H. Jay Wisnicki, MD

Clinical Professor of Ophthalmology and Pediatrics, Department of Ophthalmology, Division of Pediatrics, Icahn School of Medicine at Mount Sinai; Medical Director, Union Square Eye Care, New York, New York

Disclosure: H. Jay Wisnicki, MD, has disclosed no relevant financial relationships.

Joseph F. Panarelli, MD

Assistant Professor, Department of Ophthalmology, Icahn School of Medicine at Mount Sinai; Glaucoma Fellowship, New York Eye and Ear Infirmary at Mount Sinai, New York, New York

Disclosure: Joseph F. Panarelli, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Aerie Pharmaceuticals; Allergan, Inc.
Received research grant from: RICBAC Foundation

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