In part 3 of a 3-part episode of The Spotlight Series Podcast, host Mario Nacinovich and Damien Gatinel, MD, PhD, of the Rothschild Foundation in Paris, discuss the first trifocal intraocular lens (IOL), FineVision. In this section of the podcast, the pair wraps up the conversation by dispelling a myth about trifocal IOLs.
Mario Nacinovich:
I’m sure the last 15 years has been a magnificent journey, but the field is constantly evolving, and evolving very quickly, quicker than it ever has.
Looking ahead, in your opinion, what lessons from the comparative outcomes and the longevity of FineVision’s popularity globally should really guide the next generation of multifocal or extended depth of focus intraocular lens innovations? Specifically, and I’m sure you think about this quite a bit, what further refinements, or what other innovations are currently underway in these areas in terms of design?
Damien Gatinel, MD, PhD:
Well, the grail would be accommodative lenses, because that would mimic the crystal land lens mechanism. By the way, it’s quite interesting to see that we could not replicate a human biological process, which probably is very sophisticated.
Mario Nacinovich:
I’ve been told that for 25 years.
Damien Gatinel, MD, PhD:
Right, me too.
Here in Florida, by the way, they’ve been working in the Bascom Palmer Optical Biophysics department, heavy on what they call Phaco-ESAT, so 25 years ago, the late, Jean-Marie Parel, who was the head, developed this technology, at least in animals.
The gel was there, but for some reason it’s still not working because probably we didn’t find a way to control PCO, opaculocapsular… Capsular opacification and all these things. I’m sure one day accommodative lenses will be there, but it’s not even on the horizon in an efficient way.
Designs that are proposed today are a bit bulky, or presumably not so efficient because they rely on principles which are a bit aside or against our most accommodation, which looks like the true way the eye accommodates ciliary, zonular sophisticated relaxing, that makes the lens, as long as it’s soft enough, rounder, and so more optically powerful.
Before we have this, we have to cope with designs. Of course, every day I scratch my head, I find another improvement to make this even better. It’s not to say something like, oh, it’s the best lens. But so far, I couldn’t find any other way to make something significantly better than diffractive technology, again, to achieve something which is reproducible and predictable.
Mario Nacinovich:
Then we’d have to make it and have the materials to create it.
Damien Gatinel, MD, PhD:
Yes, if we do something different. What I’m sometimes thinking is that maybe we will never use accommodative lenses, because by the time we make this efficient and available, we will maybe prevent the lens aging. Could be a way to solve this issue. I’m sure that anti-aging is one of the most coveted segment design in many big pharmaceutical companies, even outside pharmaceutics, we know that AI companies like Google, or they’re working in this extensively. If one day someone finds a way to prevent the body and the crystalline lens to age or restore its softness, there will be no more cataract surgery. That will be…
Mario Nacinovich:
Hopefully, we can turn science fiction into science reality.
Damien Gatinel, MD, PhD:
That will be bad for the industry. But of course, we will bounce on something new and that will be good for humanity. But at that stage, we need to do cataract surgery and we need to have lenses which provide what they are intended to provide, which is in that case of tropical true, achievable, and reproducible spectacular independence.
Mario Nacinovich:
Well, until then, we have the imperfections of an aging eye that thankfully have a bold innovation discovered by you and colleagues 15 years ago that we are now going to be introducing into the United States. Before we wrap up, I wanted you to share some practical insights for our clinicians and their prospective patients, and patients who may be listening to this, that would be appropriate for the trifocal intraocular lens. What’s the 1 myth you’d like to dispel about trifocal intraocular lenses? One myth.
Damien Gatinel, MD, PhD:
Okay. It’s easy. It’s the idea that you need to select the right image. You know, that’s a confusion between monovision and multifocality. When you look at something, you look at a distance. I look at you, I look at your document, I look to my colleagues here on the booth. I don’t have to select any image, because there’s nothing between you or my colleague here, or your document there. As long as it’s sharp enough for me to be seeing, well, it’s okay.
This image selection is a myth. It’s monovision. If you have a different vision between the two eyes, of course, your brain receives 2 different images. One is sharp, if it’s only on a non-dominant eye, and it’s blurred at near and at distance. The dominant eye is sharp, and the non-dominant eye is blurred, and then it’s a conflict.
But again, we discussed the fact that with trifocal lenses, you don’t have to do mono vision at all. What you see is what you see. As long as it is sharp enough, there’s no image selection. That’s really something. I’m happy. Thank you. To debunk this myth of the image selection with multifocal lenses, and these trifocal lenses. We could not work this way. The idea is again, that when you look at something, the distance is not an issue anymore. You have to feel like it’s sharp enough for you to function well. That’s what patients tell you, and that’s why they’re so happy. They say, “I don’t need my spectacles. I work. I function without spectacles since you did the surgery.” They never tell you, well, yesterday I was selecting the image on my TV because when they watch TV, they watch TV. There’s nothing to select.
Mario Nacinovich:
Nothing to think about.
Damien Gatinel, MD, PhD:
Yeah. When you say it makes a lot of sense. But still, if you go to conventions, you’ll see colleagues saying, oh, image selection, which they call neuroadaptation. Neuroadaptation is easy with trifocal lenses as opposed to people say, because as opposed to mono vision, there’s no image selection. That’s the key to understand. That’s really, thank you for this question because it’s very important to explain this and clarify this issue.
Mario Nacinovich:
For the thousands of new surgeons that will now finally, in the US, have experience or have the experience for trifocal technologies, a single best piece of advice that you could offer them,
Damien Gatinel, MD, PhD:
Oh, buy as many as possible and implant as many as possible. Seriously. Seriously. I would tell them, don’t hesitate to change your habits. Give a chance to FineVision. If you’re not happy with it, email me. I’m happy to explain and help you maybe in biometric calculation if you feel not confident enough.
But again, if you are familiar with trifocal technology, it will be an easy switch. If you are not, it’s a nice introduction to it. This was, by the way, the introduction of the world to trifocality, and it’s still popular now, and Europe’s seen number 1 in shares. Please do not hesitate to try it. It’s proven, glistening-free material. It’s again, glistening-free. It’s proven technology. It’s been on the market, and there’s no class actions against it. Everything is fine, fine vision. That’s my advice to the colleagues here.
Mario Nacinovich:
Are there any resources, any patient education tools, you said about the calculator, professional societies that you’d recommend for those seeking more information about trifocal lens technologies specifically?
Damien Gatinel, MD, PhD:
So yes, there are papers that explain the technology. My website is also resolves, Gatinel.com. We recently launched a website where you can compare all lenses on the market. It’s agnostic. It just includes the K-readings, the Q-asphericity. You can compare FineVision, and you will see how it compares favorably with many lenses. You can also use the ESCRS website calculator where Pearl DGS, which was again, built mostly on FineVision implantation. You can use it, but you’ll be also able to use all the formula, the modern formulas. Pearl Vision will be soon on the A-series calculator.
If people need to talk to me, they can email me, they can go to me in meetings. I’m very happy. I hope I will have direct interactions with my US colleagues by maybe doing some little tour. I’m going to Bascom Palmer just after the meeting to discuss these things with my colleagues from Florida. Very happy to do this. But I can go Minnesota, Utah, wherever.
Mario Nacinovich:
The world tour is going to begin.
Damien Gatinel, MD, PhD:
Yeah, I would say maybe when I’m young, and it’s more personal statement now, it would be a dream come true, that as the French student doctor, I would someday design something which will hit, which would hit eventually the US market. Because there’s always a little fascination for America in Europe, because it’s a country which has a lot of cultural influence on us through the movie industry, the technology, the products, the myth of the American success, etc. That’s something that I was influenced myself when I’m a kid.
Now it’s a bit of a dream come true that I almost don’t realize it yet. My friends, my parents, my family say, “Oh, you must be so happy.” I am truly, and it’s just the beginning of it. But I’m very happy that this lens is in America, because despite all that can be said about this country, it’s really a fabulous country for people who want to innovate, entrepreneur. Again, this is a new adventure, a new page, and I’m very happy to write this with my friends and colleagues in America.
Mario Nacinovich:
Well, we are certainly grateful for all the work and time and energy and effort that you’ve put in and all of your colleagues’ overall surgical acumen that will add to the first implantations of this in the United States. It’s truly the opportunity to enable freedom from glasses for patients with their far, intermediate, and near vision. Professor Gatinel, thank you again.
Damien Gatinel, MD, PhD:
Thank you so much.
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