"In 2010, about 215000 premium IOLs were implanted in Europe," said Dr Colin, professor and chairman, Department of Ophthalmology, Bordeaux University Medical School, France. "However, this volume represents only 7.2% of the pseudophakic IOL market, which suggests we can do better in the future." 

Recent data indicate multifocal IOLs dominate the premium IOL market, accounting for about 40% of premium implants, but they are followed closely by toric IOLs, which had a 36% share, while accommodating IOLs and phakic IOLs represented only about 10% of the procedures. 

Among multifocal IOLs being used in Europe, the acrylic apodized diffractive IOL (AcrySof ReSTOR, Alcon Laboratories) and microincisional, aspheric, hydrophilic acrylic IOL with a hydrophobic surface (AT Lisa, Carl Zeiss Meditec), which represent the first two entries in modern diffractive multifocal IOLs, enjoy appreciable market shares. Use of the aspheric multifocal IOL with a diffractive design on the posterior surface [Tecnis multifocal, Abbott Medical Optics (AMO)] began to increase after the single-piece model was introduced. 

"The AcrySof ReSTOR is the leader by far, but the AT Lisa has been a popular choice in Europe and has the advantage of being injectable through a 1.8 mm incision to maintain the advantages of microincisional cataract surgery," Dr Colin said. 

There are a number of newer diffractive multifocal IOLs. These include two implants with a trifocal design to provide good vision at all distances - the OptiVis (Aaren Scientific) and the Micro F (PhysIOL), which can be implanted through a 1.8 mm incision. Other new diffractive multifocal IOLs are the Optiva (Ophta France), Diffractiva (HumanOptics), Reviol (Accomed) and Presbysmart (OphtaFrance, Prodis). 

The ReZoom (AMO), the first modern refractive multifocal IOL, continues to be used in the European community. Another refractive multifocal IOL is the iSii (Hoya), a preloaded lens that can be injected through a 2.3 mm incision. It has a hydrophobic acrylic, three-zone optic with a +3 D add and PMMA loops. Other refractive multifocal IOL options include the Lentis MPlus (Oculentis-Topcon) and the M-Flex multifocal IOL (630F, Rayner-OphtaFrance). The Lentis MPlus is a hydrophilic acrylic, aspheric lens with a hydrophobic surface and an embedded sector-shaped near vision zone with add powers of +3 or +1.5 D that can be injected through a 2 mm incision. The M-Flex multifocal IOL is an aspheric hydrophilic acrylic lens available with either 4 or 5 annular zones and +3 or +4 D add powers; it can be injected through a 2.4 mm incision. 

Options for toric IOLs are also expanding, and the introduction of a toric version of the AcrySof multifocal IOL was a welcome addition because it expanded the pool of patient candidates for this multifocal IOL surgery. Other multifocal toric IOLs available include the Lentis MPlus toric, M-Flex T, AT LISA toric, and AT Torbi 709 M, while several other European companies are also developing new toric IOLs with designs that will provide stability in the bag for good refractive results. 

Premium IOL market offers numerous options, technologies for European surgeons