Extended depth of field lenses: Types, lights and shadows

Alió, J.L.

doi:10.1016/j.oftale.2021.07.002

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Alió" "autores" => array:1 [ 0 => array:4 [ "nombre" => "J.L." "apellidos" => "Alió" "email" => array:1 [ 0 => "jlalio@vissum.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Catedrático de Oftalmología, Universidad Miguel Hernández, Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Vissum Miranza, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lentes de profundidad de foco extendida: sus tipos, sus luces y sus sombras" ] ] "textoCompleto" => "Over the past 2 decades a historic paradigm shift in cataract surgery has emerged.While cataract surgery historically had a therapeutic objective, such as restoring vision, it gradually developed to not only achieve an adequate visual outcome, but also improve the outcome and achieve spectacle independence. There is evidence that spectacle independence improves the quality of life of the cataract patient and, in addition, lens surgery offers an "a la carte" opportunity to solve most of the refractive problems of the eye.This paradigm shift has transformed cataract surgery from a vision-restoring procedure to a refractive procedure, for the benefit of quality of life and patient satisfaction. This paradigm shift has recently been highlighted, as well as the convergence that currently exists between lens surgery and modern refractive surgery.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>In the search for this privilege offered by lens surgery, such as independence from glasses at all distances, an important technological development of intraocular lenses has arisen, initially with multifocal lenses of different types, which have given very good results, although always affected by certain complications that sometimes caused the procedure to fail, such as dysphotopsia and loss of visual quality.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> More recently, and seeking to eliminate these problems derived from the multifocal decomposition of light, new lenses have emerged called extended depth of field lenses (EDOF), which aim to occupy the intermediate space between the monofocal lens, in which dysphotopsias are practically absent, but there is no independence of glasses, and the multifocal lens, in which this independence of glasses can have a symptomatological cost for the patient.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a>It must be recognized, however, that the appearance of EDOF lenses has arisen within a very confusing commercial environment which has led to significant disorientation of surgeons and commercial abuse by some companies that have masked as EDOF lenses that were really multifocal and were therefore affected by the same problems as these, and to an exaggeration of the potential results that can be obtained with them, which has led to many mistakes in their selection.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a>What are EDOF lenses? We call EDOF lenses those that through a diverse optical mechanism, which can vary from the manipulation of spherical aberration or other radial orders, special profiles of the anterior face of the lens that lead to an increase in focus linked to a number of optical artifacts, enable in practice an improvement of intermediate vision and to some extent near vision, showing minimal photic affectations, typical of multifocal lenses. Within this broad concept, it must be recognized that true EDOF lenses are only those based on a special design of the aberrometric profile of the patient, while others are simply low power multifocal lenses that, because of their low addition, are unlikely to cause photic discomfort to the patient.The practical definition of an EDOF lens would be given by the clinical defocus curve, in which the classic focal peaks would not be observed in it, but an extension of the focal plane from the distant to the nearer distances. This effect on the defocus curve can be achieved in practice in various ways.Based on these criteria, we classify EDOF lenses into 5 types, which allow us to typify them and, thus, allow the surgeon who chooses them to know what the characteristics of the lens they present to him/her are.EDOF type 1 lensesThese lenses are based on the manipulation of the spherical aberration of the lens. This group comprises lenses that feature a sometimes exaggerated induction of the spherical aberrations, both positive and negative, which increases the depth of focus in a way proportional to the magnitude of the induced aberrations. The magnitude of this manipulation progressively degrades retinal image quality. Some of these lenses have turned out to be real clinical failures despite the advertising campaings that promoted them. The Mini WELL® lens (Sifi) and the WF IOL® belong to this group of lenses. The latter offered results of up to +3 diopters of EDOF effect and finally closed its factory due to poor results in 2018. The use of these lenses must take into account the magnitude of spherical aberration of the cornea in order to obtain adequate clinical results.EDOF type 2 lensesBased on the pinhole principle, a principle well known to all ophthalmologists, which reduces the entry of light to those rays that are parallel to the visual axis and consequently, and being a small diameter (1.3–1.6 mm), eliminate the impact of the refractive error and minimize the aberrations of the optical system and the corneal system. AC7® (Acufocus) lenses belong to this group. Although these lenses fulfil their function, they cause a loss of the peripheral visual field which only becomes apparent at a measurement of 60.° Companies have once again abused the advertising of these lenses, attributing a null effect on the visual field which is not true given that the work carried out is limited to visual field measurements at 30°.EDOF lenses type 3These are multifocal lenses with low addition. They can be of refractive and diffractive type. They are not true EDOF lenses, but can be assimilated to this group only by the profile of their defocus curve.EDOF lenses type 4Hybrid lenses in which a limited near addition is associated with a modest manipulation of the spherical aberration of the lens in the negative sense. These lenses are similar to the previous ones, although they try to increase somewhat the effect of near addition. Like the previous type, they are generally insufficient for near vision. The most significant model of these lenses is the Tecnis Symfony®.EDOF type 5 lenses: single vision “plus”These are lenses in which a variation in the geometry of their central zone causes either a change in the power of the lens from the centre to the periphery which increases the power of the lens from the periphery to the centre of the optic (Tecnis EyeHance® lens, Johnson & Johnson), or an elongation of the focus (Vivity® lens, from Alcon). Their optical principles have not yet been well explained by their manufacturers. These lenses lack dysphotopsia and produce good central vision.This classification can allow the clinician to know where he/she stands at any given moment when offered a new EDOF lens. The anterior segment surgeon's knowledge of these lenses and their proper use is undoubtedly an opportunity for the cataract or refractive lensectomy patient. However, their results in terms of obtaining quality near vision are generally inferior to those of multifocal lenses, but they require less neuroadaptation and are a conservative but convenient alternative for many patients.FundingThis study has been partially funded by the Thematic Network for Cooperative Health Research OFTARED (Reference: RD16/0008/0012). It has also been funded by the Instituto de Salud Carlos III/Agencia Estatal de Investigación and by the European Regional Development Fund (ERDF) “A way of doing Europe”.Conflict of interestsThe authors declare no conflict of interest." 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Arch Soc Esp Oftalmol. 2021;96:507–508." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Refractive surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.I. Kim" 1 => "J.L. Alió del Barrio" 2 => "M. Wilkins" 3 => "B. Cochener" 4 => "M. Ang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(18)33209-4" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2019" "volumen" => "393" "paginaInicial" => "2085" "paginaFinal" => "2209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31106754" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multifocal intraocular lenses. The art and the practice (essentials in ophthalmology)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Alió" 1 => "J. Pikkel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "edicion" => "2nd ed." "fecha" => "2019" "editorial" => "Springer" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extendeddepth-of-field intraocular lenses: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Kanclerz" 1 => "F. Toto" 2 => "A. Grzybowski" 3 => "J.L. Alio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Asia Pac J Ophthalmol (Phila)" "fecha" => "2020" "volumen" => "9" "paginaInicial" => "194" "paginaFinal" => "202" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presbyopic lenses: evidence, masquerade news, andfake news" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.L. Alio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Asia Pac J Ophthalmol (Phila)" "fecha" => "2019" "volumen" => "8" "paginaInicial" => "273" "paginaFinal" => "274" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009600000010/v1_202110060813/S2173579421001298/v1_202110060813/en/main.assets" "Apartado" => array:4 [ "identificador" => "5814" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009600000010/v1_202110060813/S2173579421001298/v1_202110060813/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579421001298?idApp=UINPBA00004N"]

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Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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