EyeWorld Asia-Pacific September 2011 Issue

30 EW CATARACT/IOL September 2011 Three surgeons share their most important tips for increasing patient satisfaction with presbyopia-correcting IOLs N o matter which presbyopia-correcting IOL you favor, be it the ReSTOR (Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland), Tecnis (Abbott Medical Optics, AMO, Santa Ana, Calif., USA), or Crystalens (Bausch & Lomb, Rochester, NY, USA), experts agree that achieving the best possible outcomes begins with one critical component: the pre-op exam. EyeWorld spoke with Richard Tipperman, MD, Wills Eye Hospital, Philadelphia, Pa., USA; Y. Ralph Chu, MD, adjunct associate professor of ophthalmology, University of Minnesota, Minneapolis, Minn., USA, and clinical professor of ophthalmology, University of Utah, Salt Lake City, Utah, USA; and William B. Trattler, MD , cornea specialist, Center for Excellence in Eye Care, Miami, Fla., USA, for tips on attaining spectacular outcomes with each and every patient. The feedback was largely universal. Proper patient selection and an extensive pre-op exam will take you far. “So much of it boils down to patient selection from the get-go,” said Dr. Tipperman. “For me, that’s someone who has minimal to no astigmatism so I don’t have to deal with doing a limbal relaxing incision. The number one cause of patient dissatisfaction with any of the premium IOLs is not hitting plano.” Dr. Tipperman stressed the importance of doing a comprehensive eye exam, looking for issues such as dry eye and meibomian gland dysfunction. Although he agreed that these eye issues and ones like it need to be addressed before surgery, it’s not for reasons you might expect. “I think all of those factors affect the surgeon’s ability to get good biometry,” he said. “Treating these things helps because it allows the surgeon to get an accurate biometry, which makes it easier to nail the postoperative refraction.” Dr. Chu agreed, noting that achieving good outcomes starts in the clinic, well before the patient is on the operating table. For him, getting accurate keratometry Presbyopia-correcting IOL pearls by Faith A. Hayden EyeWorld Staff Writer readings and a solid pre-op topography are key so any existing astigmatism can be diagnosed and discussed with the patient. “The patient has to understand what the best options are for him or her,” he said. Much like the ReSTOR and Crystalens, the key to success with the Tecnis is a healthy ocular surface. Any dry eye or blepharitis must be addressed pre-op because an inaccurate keratometry can lead to the wrong IOL power, said Dr. Trattler. To avoid post-op surprises with the Tecnis, he suggested the following pre-op tests: topography, OCT of the macula, and fluorescein staining of the cornea. If a patient still isn’t seeing well after surgery, he suggested looking for an often-missed condition. “The second most common issue I find after dry eye is missed epithelial basement membrane dystrophy,” said Dr. Trattler. “It degrades the quality of vision. As soon as that’s treated, results are very good.” Both Drs. Chu and Tipperman turn to the IOL Master (Carl Zeiss Meditec, Dublin, Calif., USA) for their optical biometer. In addition, Dr. Tipperman likes to make sure patients know what they are getting into before they sign off on the surgery, calling patient education “critical” to the overall process. For his patients choosing the ReSTOR lens, he likes to use the Eyemaginations (Towson, Md., USA) module, developed by David F. Chang, MD , clinical professor An implanted ReSTOR IOL (Alcon) Source: Richard Tipperman, MD I t has been more than 5 years since the currently available presbyopia- correcting IOLs were approved in the US Since then, there have been hundreds—if not thousands— of lectures, articles, and discussions on the use of these IOLs. Cataract surgeons have come a long way in a short period of time in terms of understanding the technology behind these IOLs and improving clinical outcomes. I have asked three surgeons to share a single important tip to increase patient satisfaction. Bonnie An Henderson, MD Cataract Editor continued on page 33