EyeWorld Asia-Pacific December 2012 Issue

December 2012 14 EWAP FEATURE Source: Sonia H. Yoo, MD At the multifocal junction by Maxine Lipner Senior EyeWorld Contributing Writer Weighing which IOL train to place a patient aboard I t’s one of those choices that practitioners are facing more frequently—weighing whether or not to implant a multifocal or a monofocal lens in a patient’s eye. While in the U.S. premium lenses account for 14.7% of the market, with hopes of this reaching 25-30% in the near future, not everyone is on board with them in Europe, according to Joseph Colin, MD , professor of ophthalmology, Bordeaux University Hospital, Bordeaux, France. Despite often glowing reports from the podium, premium lenses remain in the doldrums in some sectors. “We have a wide choice of refractive implants, and some of them are very popular in Europe,” Dr. Colin said. “However, when we look at the global market last year, 3 million cataract surgeries were performed in Europe, and only 7.8% of the IOLs were premium IOLs.” Likewise, predictions for 2013 show an ample increase in the toric lens sector in Europe but not as much of a rise with multifocal IOLs. The unhappy berth To determine why this was occurring, Dr. Colin considered his own experience with 20 consecutive unhappy multifocal cases that had been referred to his hospital. In these cases, he found that patients’ unhappiness was linked to a variety of underlying factors including early posterior capsular opacification (PCO), dry eye and blepharitis, significant refractive error, forme fruste keratoconus, IOL decentration, lens displacement, macular edema, and epiretinal membranes. Sometimes seemingly minor issues were to blame. “Even minimal PCO may result in a significant reduction in the quality of vision in these patients,” Dr. Colin said. Likewise, even the mildest CME may result in a significant reduction in the quality of vision in a multifocal lens patient. To increase the market for multifocal lenses, Dr. Colin touts improving patient selection, prevention, and treatment of complications, as well as education. Punching a multifocal ticket Gary J.L. Foster, MD, Fort Collins, Colo., USA, agreed that proper patient selection is imperative. He recently conducted a study on patient satisfaction with multifocal lenses. “I started the study with the hypothesis that if we could profile patients’ personalities, we could predict who would be less likely to be satisfied with multifocal lenses.” However, no specific scientific measure of personality was found to be predictive of who would be happy with their outcomes. Some factors did appear to be related; if patients were on antidepressant medication they were less likely to be satisfied with their multifocal. Paradoxically, whether they were actually depressed or not was not predictive. Whether or not patients had high or low levels of negativity in their personalities was also not prognostic. “My interpretation of the data collected is while you can’t predict who’s going to be happy based upon their personality profiling, you can predict based on their personality how they would react if they happen to be in the unsatisfied group. The key is to avoid clinic- busting personalities,” Dr. Foster said. The study also showed that the better the patient’s uncorrected visual acuity post-op, the happier he or she ultimately tended to be with multifocal lenses. Based on this, Dr. Foster changed his strategy from trying to predict who would be satisfied based on personality type to which personalities he would enjoy supporting if they were unhappy and which patients would have the highest chance of achieving great UCVA, he said. Likewise, for those who had the monofocal lens implanted, the study indicated that the better their best corrected vision, the happier they tended to be, casting doubt on maximum satisfaction for those with preexisting retinal issues. To determine who should receive the premium lens, Dr. Foster AT A GLANCE • Despite good outcomes, multifocal IOLs remain a question mark for some • Factors such as whether a patient is on an antidepressant medication or has excellent post-op acuity can help to elucidate who will do well • Correct management of the patient before and after lens implantation can influence patient satisfaction continued on page 16