An experienced eye surgeon who has managed many complex intraocular lens cases believes that lens exchanges for halos and dysphotopsia may soon be extremely uncommon thanks to the arrival of a powerful new design offering a full range of vision.
One of Dr Matthew Russell’s most challenging patients was a highly driven engineer with a demanding workload.
His daily tasks involved intricate visual demands – detailed computer work, extensive reading, and significant cognitive load. For him, even a slight reduction in visual quality could compromise his ability to work comfortably and without fatigue.
Adding to the complexity, the patient was myopic at -4.00 D and particularly sensitive to changes in vision quality. Dr Russell has been reluctant to use multifocal lenses on patients who were myopic with occupations that require high visual demands.
As he had done with many patients before, Dr Russell – an ophthalmologist in Queensland who subspecialises in refractive and cataract surgery – sat down with the engineer to explore his options and expectations. They discussed extended depth of focus (EDOF) lenses, weighed alternative solutions, and considered the inevitable trade-offs, including the risk of dysphotopsias such as night-time glare and halos.
The chosen solution? Bausch + Lomb’s enVista Envy IOL.
“He elected to have multifocal implants, fully aware that adaptation might be difficult,” says Dr Russell, who practises at OKKO Eye Specialist Centre and VSON Laser Vision Specialists in Brisbane.
The result was remarkable.
“A highly motivated patient who has returned to night driving without difficulty and is very satisfied with both his intermediate and distance vision.”
This outcome echoes the experience of nearly 40 other patients for whom Dr Russell has implanted the enVista Envy.
He admits to being pleasantly surprised – and excited – by the performance of this new hydrophobic acrylic lens, which B+L describes as a full-range-of-vision design. Despite its diffractive optics and the current buzz around EDOF technology, the enVista Envy is proving to be a strong contender.
Like Insight found with Western Australia’s Dr Rob Paul, he’s confident that it will become one of his go-to lenses for presbyopia correction.
That’s a pretty big statement from a surgeon who has experience with many different IOLs.
But Dr Russell’s confidence is supported by his own observations and the feedback from patients with the enVista Envy.
“Initial impressions are that the image quality for distance is significantly or noticeably better than the majority of other existing implants,” he says.
“I think that the range of focus between intermediate and near is more continuous than traditional trifocal implants.
“Also, the reading vision is excellent. The contrast sensitivity is good relative to other trifocal platforms, and that’s where we see patients will report that the print that they’re reading is clear, the edges are clear.”
Night-time symptoms were not eliminated, he says, but reduced.
With patients implanted with the enVista Envy, “we definitely see that the intensity of the halos is significantly reduced”, he says.
“That’s the number one benefit of that implant platform.”
That’s because the chief complaint among patients seeking out surgeons like Dr Russell for an IOL exchange is vision issues at night, including glare, halos and starburst.
He predicts surgeons using the enVista Envy will essentially be getting it right first time, with much less risk that unhappy patients will need to return to the operating table due to refractive surprises or sub-optimal outcomes.
“That is something that limits many surgeons using multifocals to a large degree, having to have the capacity to manage residual refractive error.
“We’ve got to have a method of managing that by doing laser vision correction, in up to 20% of eyes after surgery.”
That number may tumble with the enVista Envy, he says.
“There are going to be some cases that will require exchange, but we’re anticipating the rate is going to be significantly lower. And that seems to be proven to be true from our colleagues’ experience in the US.”
That is one of the reasons he has elevated the enVista Envy in his inventory.
“I’m excited about the fact that I know that patients are just going to be happier when I put this in their eye,” he says. “I think it’s going to improve our patient satisfaction.
“I would place this lens way above the traditional or previous platforms we’ve had available to us – it’s going to be in my one or two go-to intraocular lenses for multifocal surgery going forward.”
