Current Advances and Future of Premium IOLs

Purpose of Review: Advances in intraocular lens (IOL) design for cataract surgery have led to improved visual acuity outcomes and spectacle independence. There are innovative designs that have recently become available, including extended depth of focus, multifocal, and light-adjustable lens, and new technologies on the horizon such as modular IOLs. The objective of this review is to outline the current state of premium IOLs on the market and present outcome data to assess their benefits and limitations. This review will also explore premium IOLs in development. Recent Findings: Extended depth of focus (EDOF) IOLs improve functional vision over a range of distances and correct for presbyopia by creating a single, elongated focus. The IC-8 (AcuFocus) uses a small aperture and provides a promising option for patients with irregular refractive states. The AcrySof Vivity (Alcon) uses a shifting wavefront to allow extended depth of focus while reducing dysphotopsias, and the Tecnis Eyhance (J&J) uses a progressive power change to improve intermediate distance visual acuity. Multifocal IOLs such as the PanOptix (Alcon) provide effective intermediate and near visual acuity but the use of diffraction results in increased photic effects. The Tecnis Synergy (J&J) combines multifocal and EDOF technology to provide a wider range of functional focus. The development of light-adjustable lens such as RxSight makes it possible to adjust lens power postoperatively using ultraviolet irradiation. Modular IOLs are a new generation of IOLs in the pipeline that have a multiple component design to enable easier optic exchange. The Juvene (LensGen) has received investigational device exemption approval from the FDA and other modular IOLs such as Harmoni and Gemini are also in development. Summary: Innovations in IOLs are providing increased options for presbyopia correction and reducing refractive error after cataract surgery. As new IOLs are being developed to provide improved functional vision over a range of distances with minimal aberrations, patient selection remains critical to ensure improved visual outcomes and high levels of patient satisfaction.