EyeWorld Asia-Pacific September 2011 Issue

33 EW CATARACT/IOL September 2011 of ophthalmology, University of California, San Francisco, Calif., USA. “I think it’s spectacular,” Dr. Tipperman said. “Patients get a good understanding of what the lens can and can’t do. It tells them more than I ever could in a brief amount of time.” Although pre-op exam points apply to all IOLs, specific strategies vary from lens to lens. For example, Dr. Chu recommended surgeons using the Crystalens fully understand the induced refractive cylinder so they know where to place the incision. “We try to operate on the axis to intraoperatively reduce any pre-existing corneal astigmatism,” he said. “Trying to get less than .75 D of astigmatism per patient is critical to having the best outcomes.” For the ReSTOR, Dr. Tipperman advised surgeons to avoid making too small a capsulorhexis because the central 3.6 mm of the IOL optic is the apodized diffractive portion, while the remaining peripheral portion of the optic is purely refractive and for distance. Keeping the capsulorhexis large enough—so that much of the peripheral refractive portion of the IOL is uncovered—helps ensure excellent photopic and mesopic quality vision. He also spoke about ring centration, pointing out that the ReSTOR should be centered on the patient’s true visual axis, which may or may not be the geometric center of the pupil. “Some of the happiest patients I’ve seen are not well centered, and some of the unhappiest patients I’ve seen are perfectly centered,” he said. “What is almost certainly the On the lookout continued from page 24 Presbyopia from page 30 geometric center of the pupil is not aligned with the true visual axis for every single patient. We know there are some eyes where the actual visual axis is not the center of the pupil.” In order to ensure you’re implanting the ReSTOR in the right spot, Dr. Tipperman suggested using fixation glasses from Mastel (Rapid City, SD, USA), which consist of a high-powered magnifying glass with an LED light attached to the center of the nose. During the pre-op exam, have the patient look at you and mark where the light reflects on the patient’s cornea. “It allows the surgeon to see on the cornea where the true visual axis is,” said Dr. Tipperman. “When I’m done with the surgery and I’m about to center the ReSTOR lens, I don’t have to guess.” No matter which IOL is your favorite, it’s important to choose the best one for the patient. Patients are more educated than ever these days and may come into the office with some preconceived notions. “The fact that the patient wants it is on the bottom of my list of reasons of why I would recommend a lens,” said Dr. Tipperman. “Patients have to have a good biometry, a healthy eye, and a solid understanding of what’s involved.” EW Editors’ note: Dr. Chu has a financial interest with Bausch & Lomb. Dr. Tipperman has a financial interest with Alcon. Dr. Trattler has a financial interest with AMO. Contact information Chu: 952-835-0965, yrchu@chuvision.com Tipperman: rtipperman@mindspring.com Trattler: 305-598-2020, wtrattler@gmail.com There are cases in which Dr. Peters said he does perform pre-emptive corrections. First, he said, he sometimes opts for refractive lens exchange in patients who are going to develop cataracts soon. Otherwise, he said, good LASIK effects would be short- lived. Second, he said, in cataract patients who are at high risk for retinal detachment, he performs a special procedure. “We will do an argon laser treatment out in the areas of lattice to put on spot welding that might reduce the risk of retinal detachment during the cataract procedure,” he said. He referred to such a procedure as a “precaution”. Phillip McGeorge, MD, Perth, Australia, does not favor pre- emptive correction for the possible future induction of astigmatism in patients. “The problem with that idea is it is hard to predict the rate of progression [of against-the-rule astigmatism],” Dr. McGeorge said. “If you are already using a temporal incision that has a small amount of surgically induced astigmatism, then you can leave things to nature rather than trying to guess what might happen in 5, 10, or 20 years. All surgical or refractive procedures have a time limit.” Dr. McGeorge thinks that it is important to try to give patients excellent vision that will last as long as possible. “We are trying to give patients the best vision now and into the future as far as we can predict,” Dr. McGeorge said. EW Editors’ note: The physicians mentioned have no financial interests related to their comments. Contact information DeRose: 610-820-6320, francesco26@me.com Hayashi: hayashi-ken@hayashi.or.jp McGeorge: +61 8 9388 0569, philm@perthlaservision.com.au Peters: 603-501-5000, peters3@comcast.net Tel: +65 64936953 Fax: +65 64936955