With 1.8 billion people worldwide expected to be affected by presbyopia by 2050, and with 280 million of them located in Europe (1), it’s never been more important to design innovative ways to combat the affliction.
Today’s patients want – even expect – their vision capability to match their active lifestyles. Europeans of 55 years and older spend at least six hours per day on leisure activities, including playing games, using the computer, watching television, socializing, and participating in sports (2) – and all these daily activities require good visual acuity at various distances, ideally without spectacles. Common tasks, such as driving, also require several working distances.
And that’s why Bausch + Lomb Surgical International introduced LuxSmart – a new premium preloaded continuous extended vision IOL that the company has been evaluating realworld outcomes for over the past year, since the launch in 2020. LuxSmart has already been implanted into the eyes of over 8,000 cataract patients in 18 countries around the world. Designed to provide continuous vision from distance to intermediate, thanks to its elongated focus – and with a similar dysphotopsia profile to that of a monofocal lens – the IOL offers a solution for the range of vision needed for a variety of everyday tasks.
LuxSmart is a biconvex one-piece hydrophobic acrylic IOL with four-point fixation and a 360º square edge design. IOLs with a similar fixation design have shown good centration, rotational stability, and greater refractive predictability. Rather than creating one (monofocal) or several distinct focal points (multifocal), LuxSmart’s design provides a wider continuous range of functional vision. The shape of the lens has been designed to optimize its post-cataract surgery behavior in the capsular bag. And thanks to the single-step, fully preloaded injection, there is less risk of damaging or mishandling the IOL, less wound stretching, with more predictable IOL delivery. Bausch + Lomb has been using the through-focus MTFa (Modulation Transfer Function a, an objective metrics shown to correlate well with binocular visual acuity) to predict the clinical defocus visual acuity curves of an average patient. Assuming MTFa = 20 as a threshold for VA ≈ 0.0 logMAR, as several studies have demonstrated, LuxSmart achieves a Useful Range of Vision (URV) of 2.3 D for a 2 mm pupil size, of 1.7 D for 3.0 mm and of 0.8 D for 4.5 mm (3, 4, 5, 6).
LuxSmart uses a novel optical concept: Pure Refractive Optics (PRO) Technology, where the design is based only on refractive profiles, meaning there are no diffraction areas, which helps avoid photic phenomena. With no diffractive optical profile, the IOL has a refractive surface across the entire optical diameter, starting with elongated focus (elongation of depth of focus) 2-mm center of the lens with the combination of fourth and sixth orders of spherical aberration of opposite signs. Moving away from the center, a patented transition zone smoothly decreases the optic vergence from the center to the periphery, while controlling the trajectory of light to ensure no light lands outside the range of vision, resulting in no light loss. Finally, in the periphery, the lens is finished with a refractive aspheric surface.
Robert Hörster recently shared his results based on around 150 LuxSmart IOLs he has implanted, some of which were included in a comparison of 82 eyes implanted with LuxSmart and 84 eyes implanted with monofocal aspheric IOLs (7). According to the results from his clinic, at three months, LuxSmart eyes exhibited superior intermediate visual acuity, without degradation of distance visual acuity. Hörster also noted that in LuxSmart patients, unlike monofocal patients, visual acuity evolved during the first three months: spherical equivalent was -0.5 diopters at six weeks and -0.2 diopters at three months.
The LuxSmart premium IOL and the monofocal LuxGood lens both comprise a hydrophobic material and represent the launch of a new Lux platform for Bausch + Lomb, forming part of a complete range of innovative IOLs. A toric version using the same platform will shortly become available. The platform is available with or without violet light filtering, in clear and yellow options.
Approvals may vary by country. LuxSmart is currently not available in the US.
https://www.luxsmartiol.com
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References
- A Grzybowski et al., Asia Pac J Ophthalmol (Phila), 9, 226 (2020). PMID: 32511122.
- F Ribeiro et al., J Cataract Refract Surg, 46, S1 (2020). PMID: 32126025.
- F Vega et al., Biomed Opt Express, 9, 4893 (2018). PMID: 30319910.
- A Alarcon et al., Biomed Opt Express, 7, 1877 (2016). PMID: 27231628.
- J Armengol et al., Biomed Opt Express, 11, 2818 (2020). PMID: 32499963.
- JA Azor et al., Millan Grupo de Optica Aplicada y Procesado de Imagen (GOAPI). Department of Optics and Optometry Universitat Politecnica de Catalunya BARCELONATECH.
- R Hörster, Symposium at the 39th Congress of the ESCRS; October 9, 2021; Amsterdam, The Netherlands.
