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32 | EYEWORLD DAILY NEWS | MAY 17, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING continued on page 34 'Best of the Best' in advanced cataract surgery in 2020 different lens options. He noted the trifocal lens performance and said there is a shift in the marketplace and the clinic toward this option. Dr. Holladay also touched on chromatic aberration. All corneas have a similar amount of chromatic aberration, and proprietary achromat- ic technology is optimized to counteract the chromatic aberration of the cornea. The net result is reduced chromatic aberration. Looking at these lenses overall, Dr. Holladay said that the binocular distance visual acuity for all lenses is excellent. You get no aberrations or prob- lems with halos and glare with pinhole or monofocal, and you get about 1+ or 2+ when you use diffractive optics, he said. David Chang, MD, Los Altos, California, presented on the Light Adjustable Lens (LAL, 20/12, Dr. Holladay said, because the pinhole causes diffraction. For an EDOF lens, it may be around 20/16, and diffractive bifocals and trifocals might be around 20/20 for theoretical vision. However, those are theo- retical, he said, and the actual BSCVA with FDA studies are different. "We don't have a lot of people who are diffraction limited and have absolutely perfect retinas," he said. The average is about 20/17 with an aspherical monofocal, 20/16 with a pinhole lenses, 20/18 with an EDOF IOL, and 20/22 for diffractive bifocal and dif- fractive trifocal lenses. Contrast loss with aspheric and pinholes is zero, he said. It's about 20% with an EDOF, 25% with a diffractive bifocal, and 30% with a diffractive trifocal. Dr. Holladay showed graphs comparing the per- formance among some of the ideally a gradual change from one focal point to the other. How is the optical per- formance of these lenses compared? Dr. Holladay shared the six things to measure as metrics for IOLs: 1. High-contrast BDCVA at distance (4–6 m) 2. High-contrast BDCVA at intermediate (66 cm) 3. High-contrast BDCVA at near (40 cm) 4. Stereopsis 5. Contrast sensitivity function (CSF) 6. Visual disturbances (halos, glare, etc.) Dr. Holladay shared com- parisons among different IOLs of what's normal. Perfect vision is about 20/09 or 20/10. With an aspherical monofocal that corrects all spherical aberra- tion, there are people who see 20/09. The theoretical vision with other lenses is slightly less than this. A pinhole lens is around by Ellen Stodola Editorial Co-Director A "Best of the Best" instruction course provided updates on advanced cataract surgery in 2020. Jack Holladay, MD, Houston, Texas, discussed optics and clinical performance of monofocal, EDOF, pinhole, and diffractive bifocal and trifocal IOLs. The first thing we need to understand is how rays of light pass through the lens, he said. For a monofocal IOL, there is a single focal point, the rays converge to this point, then they diverge when they go past. For a bifocal lens, dif- fractive or refractive, there are two focal points, and the main concept is the first focal point will defocus and form a spot or circle at the secondary focal point and vice versa. There is also a zonal refractive or EDOF, he said. In these lenses, there is In his presentation, Dr. Holladay compares the performance of different types of lenses, noting that there have been shifts toward a preference for the trifocal lens. Source: Jack Holladay, MD, screenshot from presentation

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