April 11, 2025
6 min read
This story has a lot of personal sentiment and comes from the last words spoken by my brother at the end of 2018, the day he decided to tell his best friend — me — that he was dying of cancer.
I barely made the last flight from Chicago to Los Angeles that day to hear his final words: “Promise you will never say I wish but say I did.” He made me repeat it and then uttered, “Get me that Vegas gig, DJMJ.” Then, in 2023, at age 59, I opened for DJ Zedd in front of 5,000 people at Zouk Nightclub and DJ Kaskade in front of a sold-out crowd at Ayu Dayclub, both in Las Vegas.
For those who do not know me, I professionally DJ as a second job, which has really elevated in the last few years. The story of #IDID goes beyond helping me as a DJ professionally — it also taught me a great lesson, and I wished I realized this earlier in my life. I have since created the four rules of #IDID, with the third rule having applicability here: Rule 3 — care about yourself/stay healthy. In 2025, we are loaded with premium options for our patients in cataract and refractive surgery, with more coming in the near future. I am going to review several of these options in this article because now is the time for our patients to say #IDID and follow rule 3 (care about themselves/stay healthy).
LAL+
The LAL+ optical design further extends the depth of focus from the original design of the Light Adjustable Lens (RxSight) by adding a small continuous increase in central lens power relative to the LAL. This change does not affect projection of light patterns into the lens from the Light Delivery Device (LDD), enabling the same light treatments to be used. The LAL+ compared with the LAL itself has the same surgical planning, same insertion technique, same clinical workup and same LDD treatment planning/process, and it is particularly effective in subjects who desire bilateral emmetropia. RxSight has a patient data registry of its technology, and 93.5% of patients are within 0.5 D on the intended manifest spherical equivalent intended postoperatively, with 92% 20/20 or better and 93% J1+ or better postoperatively. This technology is available from –2 D to +30 D to use intraoperatively. In my experience, I have corrected up to 2.5 D of astigmatism if with the rule preoperatively and up to 3 D of astigmatism if against the rule preoperatively. The newest IOL injector allows for insertion of this technology through a 2.2-mm incision. It is recommended to use the LAL and not the LAL+ in patients with higher-order aberrations in the cornea preoperatively, which is most common in post-refractive surgery (LASIK, PRK) patients.
Envy
Built on the enVista advanced optics monofocal platform, the enVista Envy trifocal (Bausch + Lomb) received FDA approval in October 2024. This lens has been quite enviable as it relates to dysphotopsias, with 89% with little to no glare and 80% with little to no halo and only 3% with severe disturbances. With ActivSync Optics, the enVista Envy IOL features an apodized diffractive anterior surface with a 1.2-mm central zone, providing 1.6 D intermediate and 3.1 D near add. This design ensures a consistent –0.15 µm spherical aberration profile across the full diopter range, delivering precise and reliable vision correction. The enVista Envy is enhanced with proprietary ClearPath technology, which aims to reduce light scattering and was developed as an anti-glare coating. Target refraction in the FDA clinical studies was –0.02 in each eye, and 78% were within ±0.5 D postoperatively. The enVista Envy IOL offers the lowest available cylinder treatment, starting at 1.25 D at the IOL plane, ensuring precise correction for mild astigmatism. For patients with higher levels of astigmatism, the enVista Envy IOL provides treatment up to 5.75 D at the IOL plane, addressing a wide range of patient needs. It is the only toric platform that treats half-step cylinders up to 3.5 D at the IOL plane, allowing for tailored and precise vision correction across the full range of astigmatic conditions. The enVista toric platform features 110° of capsular bag contact, ensuring exceptional rotational stability within the eye. It delivers 300% more radial compression force compared with traditional hydrophobic IOLs, providing stability and reducing the risk for lens rotation.
Odyssey
Distance image quality was assessed under realistic conditions using the ACE model eye, which includes spherical and chromatic aberration of the average eye, measured with white light. Tecnis Odyssey (Johnson & Johnson Vision), built on the premium Tecnis platform, features a high Abbe number and full correction of corneal spherical aberration. Its proprietary achromatic technology also actively corrects chromatic aberration for distance vision. This combination ensures high image quality day and night. Additionally, the Odyssey demonstrates less modulation transfer function loss when the pupil dilates from photopic to mesopic conditions, indicating reduced pupil dependency and high performance in low-light environments. The incidence of visual symptoms reported from 96 patients implanted bilaterally with the Tecnis Odyssey IOL in a retrospective, multicenter, real-world U.S. clinical study were: halos: mild 11.5%, moderate 4.2%, severe 3.1%; glare: mild 6.3%, moderate 4.2%, severe 2.1%; there were no reports of starbursts. In computer-simulated physiological eye models, 96% of eyes achieved monocular simulated visual acuity of 20/25 or better in the presence of 0.5 D residual focus, and 98% of eyes achieved monocular simulated visual acuity of 20/25 or better in the presence of 0.75 D residual cylinder.
Qlosi
Pronounced “CLOH-see,” Qlosi (pilocarpine hydrochloride ophthalmic solution 0.4%, Orasis Pharmaceuticals) is indicated for the treatment of presbyopia in adults, has the lowest effective concentration of pilocarpine approved and is preservative free, and only one drop needs to be instilled in each eye daily. This can be repeated a second time after 2 to 3 hours for an effect of up to 8 hours. Qlosi can be administered on a daily basis or as needed up to twice each day. The most common adverse reactions of headache and instillation site pain occurred in 6.8% and 5.8% of participants, respectively. Of all Qlosi participants, only 1.3% reported moderate treatment-related adverse events. All others were mild. FDA approval occurred in October 2023, and commercial release is expected early this year. Up to 86% of participants experienced 20/40 binocular vision in early to moderate presbyopes on day 15.
Laser scleral microporation
Ace Vision Group is set to revolutionize presbyopia treatment with laser scleral microporation (LSM), a natural and bilateral solution designed to restore near vision. The innovative procedure is preparing to enter FDA trials in 2026, with a 510(k) approval pathway that will allow surgeons earlier access compared with the traditional phase 3 study process.
Presbyopia, a progressive age-related condition, occurs due to advanced glycation end-products that cause scleral cross-linking, leading to increased ocular rigidity. This stiffening reduces the eye’s dynamic range of focus by limiting the ciliary muscle’s ability to deform the natural lens, ultimately impairing near vision. LSM addresses this issue by removing cross-linked tissue, restoring scleral flexibility and reactivating the extralenticular components responsible for accommodation. As a result, the ciliary muscle can once again adjust the lens, improving near vision without the need for corrective eyewear or traditional refractive surgery.
The LSM procedure is a quick in-office treatment, taking less than 10 minutes per session. Similar to LASIK, it offers a minimally invasive approach, with the added advantage of being performable remotely under the supervision of an on-site technician. The latest commercial version of the technology enhances precision and safety, ensuring accurate scleral micropore placement to minimize subconjunctival hemorrhages. Additionally, it allows for periodic enhancements to accommodate the natural aging process until cataracts develop. Unlike its predecessor, the scleral band, no reports of anterior segment ischemia have been reported with the LSM procedure.
To further improve outcomes, the LSM system integrates real-time OCT imaging, which ensures precise scleral depth targeting based on individual patient anatomy. Given the variations in scleral thickness across different ethnicities, achieving 85% to 90% micropore depth is essential for optimal results. Published clinical data have demonstrated that the benefits of this procedure last at least 24 months following treatment, using the 2.94 µm Er:YAG diode-pumped solid-state laser. Unlike corneal refractive procedures, LSM is performed outside the visual axis, eliminating the need for IOL power adjustments at the time of cataract surgery.
In summary, we currently have a great array of premium choices for presbyopia treatment. Now we need to get more patients asking for and receiving these procedures. Just let our patients know the #IDID rules of life as my brother taught me, and our percent conversions to premium technology now and in the future should continue to rise. Enjoy my new song, “#IDID,” featuring vocalist Alexia LaSaint, on all music streaming platforms. My next song, “A New Life,” comes out in April. Keep #IDID going no matter what you do in life.
References:
- Chang D, et al. Clinical evaluation of tolerance to residual refractive errors following implantation with a new diffractive presbyopia correcting IOL. Presented at: American Society of Cataract and Refractive Surgery meeting; April 5-8, 2024; Boston.
- enVista Envy hydrophobic acrylic IOL. https://www.bauschsurgical.com/cataract/envista-envy/#HIGHLIGHTS. Accessed March 7, 2025.
- Holland E, et al. Clin Ther. 2024;doi:10.1016/j.clinthera.2023.12.005.
- Johnson & Johnson. Data on file. DOF2023CT4050.
- Johnson & Johnson. Data on file. 2024DOF4017.
- Mathews P, et al. Real world evidence visual outcomes of a new full-range spectacle-independence intraocular lens. Presented at: Presented at: American Society of Cataract and Refractive Surgery meeting; April 5-8, 2024; Boston.
- Schultz DS, et al. Invest Ophthalmol Vis Sci. 2008;doi:10.1167/iovs.08-1970.
- Watson PG, et al. Exp Eye Res. 2004;doi:10.1016/s0014-4835(03)00212-4.
- Wilson SL, et al. Proc SPIE. 2012;doi:10.1117/12.908749.
For more information:
Mitchell A. Jackson, MD, of Jacksoneye in Lake Villa, Illinois, can be reached at mjlaserdoc@msn.com.
Sources/Disclosures
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Expert Submission
Disclosures:
Jackson reports being global medical director of Ace Vision Group, consulting for Bausch + Lomb, Johnson & Johnson Vision and RxSight, being a shareholder in Ace Vision Group and Visionary Venture Fund, and being co-producer and creator of the songs “#IDID” and “A New Life.”