Patients with ocular comorbidities implanted with bilateral Tecnis PureSee IOLs achieved excellent distance and good intermediate vision, and functional near vision according to real-world data presented by Dr. Frank Kerkhoff, Chief Medical Officer of FYEO in The Netherlands, at the 44th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS), London, England.
He conducted a retrospective analysis of 418 patients who underwent bilateral refractive lens exchange (RLE), all of whom had a history of laser vision correction (LVC, 105 patients), amblyopia (52), corneal pathology (101), maculopathy (102), or other ocular comorbidities (45) or systemic comorbidities with ocular involvement (13).
Counselling such patients, when they come to the clinic seeking freedom from glasses, can be challenging, said Dr. Kerkhoff. “The first and probably most important step is to explain that achieving complete or near-complete spectacle independence may not be medically feasible. These patients initially present with high expectations, and we have to help them understand why a more conservative optical solution is in their best interest,” he said.
In the study, patients achieved mean uncorrected binocular visual acuity -0.002 logMAR at distance, 0.131 logMAR at intermediate, and 0.224 logMAR at near, two months after RLE surgery. The proportion of patients who were 0.20 logMAR (20/32 Snellen) or better was 95.7% at distance, 78.0% at intermediate, and 45.5% at near. Distance and intermediate performance was stable across various types of comorbidities, while near vision was most affected in those with macular disease. “An important advantage of the PureSee is its non-diffractive optical design,” said Dr. Kerkhoff. “It is intended to preserve contrast sensitivity and is associated with a very low incidence of bothersome halos and other dysphotopsias.”
To extend the functional near range of this EDOF lens, FYEO surgeons often use a mild monovision strategy, targeting the dominant eye for emmetropia while the non-dominant eye is targeted slightly myopically. “Because the PureSee is relatively forgiving at distance, this approach can improve functional near vision while maintaining good binocular distance and intermediate performance,” said Dr. Kerkhoff.
He noted that the Tecnis PureSee lens fills an important gap. “For a clinic such as ours, where maximum spectacle independence is normally the primary objective, this lens offers an effective option for clients who would otherwise be considered unsuitable for a diffractive IOL because of their comorbidities. These clients may achieve a somewhat lower level of spectacle independence than those receiving a full-range-of-vision diffractive lens, particularly for reading at 30 cm. However, with careful counselling and, where appropriate, a mild monovision strategy, the PureSee can provide a broad and useful range of vision while maintaining favourable distance vision, contrast performance and a low level of dysphotopsia in eyes with comorbidities,” he said.
