EyeWorld Asia-Pacific September 2011 Issue

3 September 2011 Letter from the Editor Dear Friends T here are several options available to correct presbyopia, which are presented in this issue of EyeWorld Asia-Pacific. Our contributors to this issue emphasize that there is a balance between the potential and pitfalls for each technique. Multifocal IOLs offer a predictable result, but there is an inherent risk of reduced contrast sensitivity and occasionally troublesome glare and halos. Accommodative IOLs potentially provide better optical quality, but with presently available IOLs the near vision is less predictable. Presby-LASIK is a potential solution for phakic patients, but one wonders whether corneal remodelling will affect the outcome. Finally, with corneal inlays there is the additional issue of long-term biocompatibility that needs to be addressed. The marketplace is therefore quite crowded, but the reality is that so-called premium IOLs and solutions in total comprise only approximately 10% of lenses implanted in patients undergoing cataract surgery; monofocal IOLs comprise the remaining 90%. Monovision is quite widely practiced and a recent prospective study comparing multifocals and monovision was published earlier this year the in Journal of Cataract & Refractive Surgery . Although the outcome in both groups was similar, the monovision group experienced better intermediate vision and scored higher in terms of satisfaction with fewer patient complaints. One of our feature articles profiles this paper and several surgeons (including your editor) provide their thoughts on this intriguing “Great Debate”. In addition to the debate of multifocal IOLs versus monovision is the issue of correcting astigmatism. Although limbal incisions still have a role, toric lenses increasingly appear to be a more effective and predictable method of managing pre- existing astigmatism. A recent study published in the September 2010 issue of the Journal of Refractive Surgery provides important data supporting the use of toric lenses and is discussed in this issue. One interesting aspect that should be taken into account when selecting toric lens power is the natural progression of against-the-rule astigmatism that occurs with age and after cataract surgery. I would suggest that it may be appropriate to aim for a small amount of residual with-the- rule astigmatism rather than neutral or against-the-rule astigmatism to accommodate this progressive change, especially in younger patients. In the current issue there is an article discussing this topic and I am pleased to see that other surgeons are increasingly aware of this factor and have taken this into account in their toric lens selection. There are advocates for the different types of lenses and presbyopic solutions and it can be quite confusing for surgeons to select which technique or lens is most appropriate for their patients. Hopefully, the articles and opinions expressed in this issue will be helpful for surgeons in selecting the most appropriate lens or presbyopic solution for their patients. Warmest regards Graham Barrett, MD President, APACRS Chief Medical Editor, EyeWorld Asia-Pacific