Article Date: 6/1/2011

Advanced Technology IOLs and the OD

Advanced Technology IOLs and the OD

The IQ ReSTOR® IOL delivers on the promise of patient satisfaction and spectacle independence.

By Walter O. Whitley, OD, MBA, FAAO

Our practice is a tertiary referral center, where more than 2800 cataract surgical procedures are performed annually. More than 60% of our volume comes from direct referrals from optometrists in our area with whom we've developed strong, trusting relationships. This is key because optometrists play a critical role in the diagnosis, treatment and education of patients with cataracts.

When it comes to present-day cataract surgery, patients have high expectations, demand great outcomes and are interested in freedom from eyeglasses. Advanced technology IOLs have the ability to meet and exceed our patients' expectations, and offer them an opportunity to increase their quality of life while addressing their visual needs.

With all of our patients, we must maintain a refractive mindset. We need to think not only about what our patients' current visual needs are, but also what their needs will be in the future. The majority of our patients over age 50 will eventually need cataract surgery. When patients begin to develop early lens changes, you should initiate a discussion about future treatment options so they are prepared for what lies ahead. Several years ago, direct-to-consumer advertising had a tremendous impact on the LASIK market with advertisements in newspapers, magazines, radio and television. The same is becoming true for advanced IOL technology but patients should hear about these exciting technologies from their optometrist.

Advanced Technology IOLs

There are four presbyopia-correcting IOL options on the market including the AcrySof® IQ ReSTOR® IOL, the ReZoom and Tecnis Multifocal (Abbott Medical Optics) and the Crystalens (Bausch + Lomb). Differences between advanced IOL platforms include diffractive vs. pseudo-accommodative optics, acrylic vs. silicone material, single-piece or 3-piece IOL, blue light filters vs. no filter, aspheric vs. spherical optics and apodized vs. non-apodized optics. Each technology has its strengths and weaknesses but no matter the difference, the goal for patients is spectacle independence. Although the majority of cataract patients choose standard monofocal IOLs, advanced technology IOLs represent an increasingly popular treatment option that maximizes visual outcomes.

The Crystalens is a pseudo-accommodative IOL, so the lens should use the natural focusing ability of the eye to provide a single focal point. However, long-term stability in the human eye has not been established, so surgeons should continue to monitor implant patients postoperatively on a regular basis.1

Diffractive IOLs, including the Tecnis Multifocal and the IQ ReSTOR IOL, contain physical steps that divide light waves into wavelets that form a distance and near image. The difference between these options is how diffraction is utilized in the IOL.

The Tecnis Multifocal, which has a 4.0 D add, has a wavefront-designed aspheric anterior surface and a fully diffractive posterior surface. One main disadvantage of this technology is that the near add may be too close for comfortable reading vision for many patients.

The IQ ReSTOR IOL is the only multifocal IOL that utilizes both aspheric, apodized diffractive and refractive optics. The central 3.6 mm apodized, diffractive surface distributes light waves to both a distance and near object with varying step heights. As the pupil size increases, more light energy is directed to the distance, which improves certain activities such as driving at night. The outer zone of the IQ ReSTOR IOL includes a refractive zone that maximizes distance vision. The apodized design helps improve image quality and energy balance.

Benefits of Apodized, Diffractive Optics

Apodization is one of the differentiating features of the ReSTOR IOL technology. It's a term used to describe a lens system in which there's a gradual modification of the optical properties of a lens as you move from the center to the edge. Apodization is commonly used in astronomy and microscopy to enhance image quality. With the addition of aspheric optics to improve contrast sensitivity and functional performance in nighttime conditions, the ReSTOR IOL effectively controls image quality and energy balance to maximize our vision.

AcrySof IQ ReSTOR IOL Technology

Although we have experience with all of the IOLs, in my practice, our preferred advanced technology IOL is the Alcon AcrySof IQ ReSTOR +3.0 D, because we believe it delivers on the promise of patient satisfaction and spectacle independence. More than 93% of patients implanted with AcrySof IQ ReSTOR IOL technology would elect to have the lens implanted again.2 First introduced in 2005, Alcon's ReSTOR +4.0 D IOL has been proven to enhance patient quality and quantity of vision. The ReSTOR +4.0 D IOL provided excellent near VA at 33 cm (13 in) and excellent distance VA. However, the intermediate VA (around 50-70 cm) was lower than desired for some individuals. To address this concern, Alcon modified its IOL technology and released the IQ ReSTOR +3.0 D IOL, which provides excellent visual acuity at near, intermediate and distance. The near vision peak was moved out by about 3 inches relative to the +4.0 add optic. The intermediate visual acuity is enhanced in the 40-50 cm (16-20 inch) range. The IQ ReSTOR +3.0 D IOL thus provides better visual performance at all distances compared to a +4.0 add optic (Figure 1). These benefits are evident in the overwhelming acceptance and preference of the IQ ReSTOR IOL for patients and practitioners alike. According to Market Scope's Q4-2010 Survey of U.S. cataract surgeons (n=423), Alcon's AcrySof IQ ReSTOR multifocal IOL was the market leader, used in 50.9% of all IOL procedures that included a presbyopia-correcting IOL. Other presbyopia-correcting IOLs used included the Tecnis multifocal, the ReZoom and the Crystalens.3

Figure 1. The AcrySof IQ ReSTOR IOL with +3.0 D add power provides an optimal near vision peak further out and enhanced intermediate visual range without any sacrifice on distance vision compared to a +4.0 D add power.

Patient Education

When making a recommendation, the number one priority should always be patient satisfaction and outcomes. With advanced technology IOLs, we can meet and exceed our patients' expectations. Advanced technology IOLs have provided an opportunity to offer patients cutting-edge technology and also tangible and intangible benefits. By recommending advanced technology IOLs, we show that we're at the forefront of eye care technology. You can brand your practice as not just a place to get eyeglasses and contacts, but also a place that provides cutting-edge technology. Positive results will ensure patient loyalty and new patient referrals.


1. Crystalens package insert.
2. AcrySof IQ ReSTOR IOL. Directions for Use.
3. Market Scope, Q4-2010 Survey of U.S. cataract surgeons.

Dr. Whitley is director of optometric services at Virginia Eye Consultants, in Norfolk, a tertiary referral care center. He is an adjunct assistant clinical professor at Pacific University, Pennsylvania College of Optometry and Southern California College of Optometry.

Optometric Management, Issue: June 2011