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S ome intraocular lenses are a little more forgiving for patients and surgeons, while providing ex- ceptional quality of vision, than others. Such is the case with the aberration-free enVista ® IOL (Bausch + Lomb, Bridgewater, N.J.), which offers uniform power from edge to edge. Surgeons in our practice have found that serious visual impacts can occur among lenses that lack a uniform power design following any lens decentration due to natural changes in the capsular bag, asymmetric contraction of the bag, or decentration from pseudoex- foliation syndrome—which includes some patients who have glaucoma. Any of those changes can naturally decenter the lens, and a lack of uniformity in the way the lens works can produce image distortions and dysphotopsias, which are symptomatic for the patient. This decentration manifests as patient complaints of glare or halos at night or the presence of an extra arc of light. The uniformity of the enVista IOL optic design means that even if decentration occurs for any reason, patients may not suffer a loss of visual acuity or other changes, depending on the extent. 1,2 Since our practice starts with the goal of providing excellent visual out- comes for all of our patients, this uniformity is a feature of the lenses to get excited about. Our patients—whether we want to admit it or not—judge us based on our delivery of high quality visual outcomes. The patient is not going to come to us and say, "The lens you put in has negative asphericity or positive asphericity or positive aberrations or negative aberrations." They don't know any better. If they have surgery and don't see well or are not able to get the desired quality satisfaction scores, then you are at fault. Another advantage of the enVista lens design, practically speaking, is the larger sur- gical sweet spot due to the lack of aberrations in the lens optic. 1,2 This makes it a much more forgiving lens to implant, especially in the high-volume practice that can not afford to tie up chair time on patients who are not happy. The effects of such unhappy patients can extend to their contacts and to the re- ferring physicians. You don't want a practice killer, you want a practice promoter. In my experience, this lens lends itself to that. I try to use aberration-free lenses in all of my premium IOL patients. However, in patients who have had laser refractive surger- ies, sometimes a positive aberration lens may lend itself to better acuity. But even those pa- tients require spectacles. So at the end of the day you want to have minimal aberrations. The leading factors that have driven my use of the enVista lens over the last 3 years are the advantages offered by the AO optic and the glistening-free quality of the optic. 1,2,3 Glistenings are a manufacturing byprod- uct caused by vacuoles throughout the lens material, which have been shown to cause retinal stray light and unfortunately produce changes in the visual acuity of recipient patients. 4,5 Research has shown that implan- tation of such lenses in high volumes is likely to produce a subset of patients who can experience a decrease in visual acuity. 4,5 In our large volume clinic we have seen changes consistent with a drop off in visual acuity, so we're concerned about it. Any time we can move away from tech- nology that leads to glistenings is a plus for patients. If there are lens materials out there more effective in reducing the incidence of glistenings, that is a clear advantage. The enVista platform is among those that address this concern, but it has the additional advan- tage of the aspheric, aberration-free optic. 6 Another advantage of the enVista that makes it attractive to me as a surgeon is its hardened lens surface. The surface provides the potential for increased resistance of scratching the lens 7 —especially when loading the lens. Surgeons with an inexperienced technician who fumbles loading the lens or a technician who is rougher with the technol- ogy may discover a permanently scratched anterior aspect of the lens. All surgeons know that any lack of per- fection in a lens—regardless of who damaged it—becomes their problem. So familiarity with such lens nuances is important. A final noteworthy advantage of the enVista lens in my experience is its consistent strength in providing patients with quality vision. I continue to experience excellent results with this lens and will continue to utilize it in my practice. Dr. Sadri is in private practice at Atlantis Eyecare in Newport Beach, Calif. He can be contacted at esadrii@gmail.com. Premium vision series A forgiving lens for patients, surgeons Supplement to EyeWorld July 2015 digital.eyeworld.org The news magazine of the American Society of Cataract & Refractive Surgery Sponsored by Bausch + Lomb Beauty shot of the enVista ® IOL by Ehsan Sadri, MD, FACS

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