An eye surgeon with a great deal of his work in the regions talks about the IOL he uses often for patients with very particular and important needs.
When ophthalmologist Dr Daniel Athavale thinks about cataract surgery in regional Australia, one story returns to him time and again.
A woman in her 60s, living hours from the nearest major town, had been functionally blind for years.
“I’ll never forget her,” he says. “She hadn’t been able to see her sister for two years; she was ‘count fingers and count fingers’, couldn’t see anything,” Dr Athavale recalls.
Also, she was terrified of hospitals, reluctant even to attend an appointment.
Her sister drove her to Moree Hospital in New South Wales, a small, single-floor facility serving a vast, vulnerable catchment.
“The day after the surgery she came and tried to kiss me. Honestly, she gave me a big hug. She was just so happy,” he says.
Bilateral white cataracts had kept her from recognising her own sister.
“When can you do my other one?” she asked Dr Athavale.
For Dr Athavale, these are the moments that define regional ophthalmology. And they’re the reason he now pays close attention to intraocular lens (IOL) selection, including the use of Rayner’s Enhanced Monovision (EMV) lens, particularly in patients who spend much of their lives driving, working the land and managing with limited health access.
The EMV was designed by Australian Professor Graham Barrett in association with Rayner. It is built on a patented non-diffractive optic design that uses controlled positive spherical aberration; it does not use light-splitting technology like many IOLs which increase depth of focus. The result is an optic that delivers a high quality of vision for distance and intermediate ranges with very little compromise.
“There’s nothing more satisfying than seeing those results,” says Dr Athavale of the IOL.
And increasingly, he’s seeing them in patients whose lifestyle needs differ sharply from those in metropolitan settings.
Dr Athavale grew up in rural NSW and says that background influences both his practice philosophy and his ongoing commitment to regional care.
After initially working metropolitan jobs during training, he began spending regular time in the country, from public cataract lists in Tamworth Hospital to visiting theatres in Moree several times a year.
He now practices in and around Newcastle, in addition to the North Shore region in Sydney, where he splits his time between private work and a significant public workload.
“There’s fabulous access to public ophthalmology in the Hunter region,”
he says.
He runs public clinics at John Hunter Hospital, and operates publicly at Belmont Hospital and Kurri Kurri Hospital, with additional theatre time further inland.
This combination of metro-adjacent and truly regional environments gives him a broad perspective on what makes country patients unique, and why their cataract surgery planning can’t follow a one-size-fits-all formula.
Regional vs metro patients
For Dr Athavale, the clinical differences between regional and metro patients fall into two main groups – pathology and lifestyle.
“They present later, and they’re tougher on themselves,” he says of his regional and rural patients.
He notes that rural patients often arrive with more advanced cataracts, or with additional pathology layered on top.
“These are patients who will ignore their own health to look after a family member or look after their farm,” he says.
And some travel extraordinary distances for care: “I just had a patient who drove all the way from Tamworth who’s going blind. They’ll get in the car and they’ll drive four hours – they don’t care. They’re used to long drives.”
UV exposure, pterygia, and more entrenched ocular surface disease are also more common.
What stands out most, however, is the reliance on the car.
“Because of the absence of public transport, it is a huge factor,” he says. “Patients routinely drive long distances, at night, in poor weather, on roads affected by floods or wildlife.”
For these patients, crisp distance vision becomes not just a preference but a safety requirement.
“Every time I pick a lens I have to think: what is your lifestyle? How do I make sure I don’t stuff this up for you?”
Dr Athavale’s introduction to Rayner’s EMV IOL came through a colleague. At the time, during training, he used a mix of IOLs depending on which consultant he was operating with.
It wasn’t until a conversation years later – “talking about lenses over dinner, it’s kind of nerdy but that’s what we were doing” – that he began to explore alternatives for patients who weren’t completely satisfied with other extended-depth-of-focus (EDOF) designs.
“They keep coming in saying: my distance vision just isn’t clear enough . . . I don’t feel happy driving without my glasses, and I thought I’d be able to,” he remembers telling a fellow ophthalmologist.
Her reply was simple: Try the EMV.
He did – cautiously at first – and now finds it suits a broad range of his patients extremely well. Particularly those in regional and rural centres.
Who benefits most?
Dr Athavale finds the EMV works best for patients wanting crisp distance vision as the priority, those needing functional intermediate for day-to-day tasks, rural patients with heavy driving requirements, especially at night, and patients with pathology that makes multifocality impractical.
He emphasises that the lens provides quality of vision without the halo/glare trade-offs some regional drivers may struggle to accept.
He is clear that while EMV is suitable for most patients, it isn’t right for everyone.
Patients demanding spectacle independence or those with lifestyles that require near work may need a different solution. And pathology still guides many decisions: severe macular disease, advanced glaucoma, or unstable corneas require more conservative choices.
But for those using the EMV, Dr Athavale says the outcomes speak for themselves.
Repeatedly, the feedback he hears from EMV patients centres on confidence behind the wheel.
Many, he says, describe clearer distance vision than they expected, stable intermediate range for daily tasks, and fewer issues with glare when driving at night – a critical requirement for rural travel.
Some even report that they now don’t need glasses for reading and other near work, which is a nice bonus given that they didn’t expect that to be possible. This is a result of the lens using positive spherical aberration to deliver the increased range of focus, and even more importantly this range can be extended further towards near vision by using a monovision approach (typically 0.5D to 1.25D offset).
Rayner says the EMV is actually designed for enhanced monovision, minimising any differences between the two eyes and providing blended vision.
The emotional transformation can be striking, says Dr Athavale.
From the woman in Moree hugging him the day after surgery, to patients returning to long-distance driving after years of fear or visual struggle, the stories reinforce why tailored IOL selection matters so much.
“Those are the most satisfying cataracts,” he says.
“Life transforming – for them, and honestly, for me too.”
Dr Athavale is looking to back up that anecdotal evidence with data.
He is approaching 250 implantations using the EMV lens and is collecting the data from those outcomes, which includes a minimum of three-month follow-up consultations either by himself or optometrists in the region.
It’s early days analysing that data but “I would say that the average visual acuity at distance is 6/6.”
That’s better than he expected and supports his confidence in the Rayner lens.
That confidence means the EMV has become his “go-to” lens – it is forgiving in terms of the wide range of patients it can benefit and particularly effective for his large regional and rural patient base.
For them, distance acuity is often non-negotiable, driving safety must be factored in. and lens choice should support, not compromise, the lifestyle that patients rely on for work, family and survival.
That’s why the EMV has become one of his most important tools for meeting those needs.
