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James McCulley, MD Offering an excellent standard lens to cataract patients T he AcrySof* (Alcon, Fort Worth, Texas) line of IOLs is, in my opinion, a fantas- tic design platform for monofocals, multifocals, and toric lenses. The AcrySof IQ monofocal IOL has lived up to its promise not only as a monofocal, but also a foundation upon which presbyopic and astigmatic correction can be applied in the multifocal and toric platforms. The basic platform features a single-piece design with excellent biomechanics and unsurpassed bio- compatibility in the lens materi- als. 1,2,3 For patients seeking excellent distance vision who don't want to pay out of pocket and/or do not mind wearing glasses after surgery, using a monofocal lens for their cataract surgery is economically fea- sible and easy. Knowing I'm using a lens that has advanced optics for maximum refractive clarity for my patients gives me even more peace of mind. For these and many more reasons, the AcrySof IQ IOL is my lens of choice. Biomechanics and design The AcrySof IQ monofocal IOL has traditionally been the true platform of the AcrySof line. Biomechanically, it centers in the bag and adheres rapidly, something particularly im- portant for premium lenses. The lens has a square edge, which, combined with the excellent centration, reduces the incidence of posterior required YAGs. 4 In fact, the Nd:YAG rates published in the AcrySof IQ IOL Directions For Use are lower than the rates included in other manufacturers' product labeling (although not all manufacturers include this information in their product labeling). 5 Also minimizing YAG rates is the bioinert hydrophobic acrylate material used in the AcrySof line. This proprietary material is neither biostimulatory nor biotoxic to the epithelial cells left behind. The lens material also offers superior fibronectin affinity to the anterior capsule, 1 which increases the chance of adhesion to the capsular bag. When the capsulorhexis overlaps the optic of the lens by as little as 1 mm, the result is a "sandwich" struc- ture, with the lens sandwiched in place between the anterior and pos- terior capsules. According to this theory, the overlap prevents further proliferation of lens epithelial cells. 6 The AcrySof lens platform fea- tures an aspheric design, which was developed with a negative spherical aberration to counteract the positive spherical aberration in the average cornea. This improves quality of vision and contrast sensitivity. The incidence of glistenings in IOLs has been a hot topic recently. To some degree, all lens materials have microvacuoles that can be ob- served under the slit lamp and are called "glistenings." 7 I've observed them in the AcrySof lens material, but in my hands, they have never had any clinical significance. I've never had a patient complain about them. AcrySof lenses manufactured today have reduced the incidence of these microvacuoles by 87%. 8 Ideal lens design In an ideal world, any lens we place in the eye would recreate the characteristics of a natural lens present in a young per- son. The blue light filtering chromophore mimics light transmissibility of the natural human lens and has been added onto the AcrySof IQ IOL platform. Without the chro- mophore, blue light is transmitted through to the retina that the retina was not designed to see, nor has adapted to see. I opt against creating an unnatural situation in the eye. Implanting the AcrySof IQ IOL to avoid blue light makes sense. A "go-to" lens The AcrySof IQ IOL is my go-to monofocal lens and has been my preferred lens for years. It offers advanced design, excellent visual quality, and the lowest labeled Nd:YAG rates of all lenses currently on the market. For cataract patients, it is a sensible and financially viable choice. Moreover, the AcrySof IQ IOL platform offers exciting possibilities for premium lens technology. I firmly believe the high quality de- sign, biomechanics, and biocompati- bility make AcrySof an excellent platform for all existing lenses and offer unparalleled promise for pre- mium lenses of the future. *AcrySof is a trademark of Novartis. References 1. Linnola RJ, Sund M, Ylonen R, Cand M, Pihlajaniemi T. Adhesion of soluble fibronectin, laminin, and collagen type IV to intraocular lens materials. J Cataract Refract Surg. 1999;25:1486-1491. 2. Oshika T, et al. Adhesion of lens capsule to intraocular lenses of PMMA, silicone, and acrylic foldable materials: an experimental study. Br J Ophthalmol. May 1998; 82:468. 3. Lane SS, Burgi P, Milios GS, Orchowski MW, Vaughan M, Schwarte E. Comparison of the biomechanical behavior of foldable intraocular lenses. J Cataract Refract Surg. 2004;30:2397- 2402. 4. Schmidbauer J, Vargas L, Apple D, Escobar- Gomez M, Izak A, Arthur S, Golescu A, Peng Q. Evaluation of neodymium:yttrium–aluminum– garnet capsulotomies in eyes implanted with AcrySof intraocular lenses. Ophthalmology. 2002;109(8):1421-6. 5. AcrySof IQ Directions For Use 6. Reijo J, Linnola. Sandwich theory: Bioactiv- ity-based explanation for posterior capsule opacification. J Cataract Refract Surg. 1997;23:1539-1542. 7. Werner L. Glistenings and surface light scattering in intraocular lenses. J Cataract Refract Surg. 2010;36:1398-1420. 8. Data on file Dr. McCulley is chair of ophthalmology, University of Texas Southwestern Medical Center, Dallas. He can be contacted at 214-648-3407. EW San Francisco 2013 5 The AcrySof IQ monofocal: a platform IOL by James McCulley, MD Advanced IOL platform provides benefits for surgeons and patients " The AcrySof IQ has the lowest labeled Nd:YAG rate of all currently available IOLs. " AcrySof IQ IOL Source: Alcon Alcon Monday_SF2103 8pages-DL_Layout 1 4/21/13 7:54 PM Page 5

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