EyeWorld Asia-Pacific September 2011 Issue

42 EW CORNEA September 2011 severe side effects. In fact, patients achieve results within the first day post-op, he said. In near reading tests, patients typically gain between four and five lines of near visual acuity. With a follow-up period of more than 2.75 years, Dr. Holzer said patients showed no change in the shape of the cornea or in the refraction. This shows the procedure is stable. “We had some discussions that maybe this biomechanical change that we induce with the femtosecond laser will change later on and then the outcome will not be as it should, but that’s not the case. We can say that after 1 week, the outcome is achieved and stable over time,” he said. In fact, patients who don’t achieve the expected results after 1 week typically do not improve. “You have your final results very early,” Dr. Holzer said. What has been observed are differences in near reading ability gained between patients, Dr. Holzer noted. Some patients can read the finest print easily, while others can read or recognize things in the near distance but find it stressful to read a book for an hour and require a bit more near vision. Therefore, this is one area of uncertainty. Selecting the right patients The typical INTRACOR patient has not developed cataracts, although it is possible for a post- cataract surgery patient to have the procedure. IOL calculation after INTRACOR is not a problem, Dr. Holzer said. The best candidate for INTRACOR is a patient with no further ocular disease, with a near add of 2.0 D or more, and with a distance refraction that should be between +0.5 D and +1.25 D spherical equivalent. The subjective cylinder should not be higher than half a diopter, he said. Surgeons should first test the patient’s level of expectation with a simulation of the effect of INTRACOR by adding a contact lens to the patient’s eye with myopia to mimic the myopic shift that the patient might have later on, Dr. Holzer said. “We ask [the patient], ‘Will you be satisfied with this vision for distance?’ and if he or she tells us it’s fine, this would be a good candidate,” he said. One reason why patient selection for INTRACOR is important is because the procedure is not easy to reverse. “To reverse it would mean doing a kind of topography and a wavefront- guided surface excimer laser. It’s not as easy to reverse it as taking a multifocal IOL out of the eye,” Dr. Holzer said. Managing patient expecta- tions As with all currently available presbyopia treatment approaches, none can offer the same vision as patients had in their 20s, Dr. Holzer said. To prepare them for this, he spends time talking with them. “What I tell my patients is no matter what kind of procedure I perform, they will be able to see near and distance, but they have to compromise. The compromise could be, for example, a change in contrast sensitivity,” he said. Patients need to know that with current presbyopia treatment procedures, good light conditions are important. Patients always have a near point at a specific distance from the eye, and they need to adapt to this new situation, Dr. Holzer said. EW Editors’ note: Dr. Hamilton has no financial interests related to his comments. Dr. Holzer has a financial interest with Technolas Perfect Vision. Dr. Jackson has financial interests with Abbott Medical Optics (Santa Ana, Calif., USA) and Allergan (Irvine, Calif., USA). Contact information Hamilton : hamilton@jsei.ucla.edu Holzer : +49 6221-566995, mike.holzer@med.uni-heidelberg.de Jackson : 613-737-8759, bjackson@ohri.ca Further developments I’m currently developing the bag-in-the-lens technique to work where there is no capsule by creating an artificial capsule that can be positioned at the level of the sclera, and the bag-in-the-lens can be inserted in the middle. EW Editors’ note: The bag-in-the-lens is approved for use in Europe and is undergoing trials for FDA approval in the US. Dr. Tassignon has a proprietary interest in the bag-in-the- lens IOL . Contact information Tassignon: +32 3821 3377, marie-jose.tassignon@uza.be Corneal from page 41 Taking from page 39