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    CLE with latest generation of advanced multifocal implants

    Spectacle independence with the multifocal Diffractiva-aA intraocular lens

    Take-home message: The number of presbyopia correcting options has increased along with the size of the presbyopic market. Clear lens exchange (CLE) is becoming a popular option as a result of the latest generation of intraocular lenses that have been shown to offer spectacle independence to a high proportion of patients. In this article, Mr Chitkara presents the 1-year results of his small study evaluating CLE with implantation of the Diffractiva-aA lens.


    As the size of the presbyopic market has increased, so too has the number of options for correcting presbyopia. However, clear lens exchange (CLE) is becoming increasingly popular mainly due to the advent of the latest generation of bi-, tri- or multifocal intraocular lenses (MIOL), which have been shown to provide an independence from spectacles to a high percentage of patients.

    Unlike other procedures, such as laser eye surgery, the great advantage of CLE is that the results are permanent. The ability to see is enhanced with both eyes working together unlike monovision where one eye is focused for distance and one eye is used for reading. Patients therefore can have a more natural vision.

    MIOLs: Not suited to everyone

    Still, if MIOLs are great options for the majority of our patients, they are not suitable for everyone. Poor multifocal candidates are those who are unable to accept some potential visual compromise in exchange for an improved quality of life. It is also not an option for patients with ocular pathologies that may limit their vision such as corneal scarring or dystrophies, age related macular degeneration (AMD), and other retinal pathologies.

    Low to moderate astigmatism is not an issue any longer with the recent development of toric MIOLs. Higher levels of astigmatism will require full correction either with toric IOLs as a piggyback lens and/or subsequently with laser corneal refractive surgery.

    Many available options

    Nowadays, there are so many presbyopia-correcting IOL models available on the European market that we can select the lens model that is the best choice for a patient. One of the models I have been routinely using since 2012 is the multifocal Diffractiva-aA from HumanOptics (Erlangen, Germany). This recently marketed single-piece hydrophilic acrylic lens (Figure 1) has a diffractive aspheric aberration-free anterior surface with a +3.5 D near addition, which ensures good functional near vision in a comfortable reading distance of approximately 40 cm.

    The diffractive structure of the MIOL is constituted of 9 diffractive circular steps; the first 3 steps are of the same height and there is a gradual decrease in the 6 remaining step heights, creating a smooth transition to distance-dominant vision as the pupil enlarges. Moreover the implant has a 360-degree square edge on the posterior surface acting as an epithelial cell barrier for PCO prevention.


    NEXT: One-year visual outcomes

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