EyeWorld Asia-Pacific December 2012 Issue

18 December 2012 EWAP FEATURE Multifocal in place at start of case. Haptic stuck so must be cut to remove optic from bag; haptic can be dissected out later or, as in this case, simply left where it causes no problem. After cutting IOL in half, first half is removed. Second half of implant can now be removed through small incision. Finally, the new implant is placed in the capsular bag. Case is completed. Source (all): Steve Safran, MD Time - from page 17 for neuroadaptation,” Dr. McCabe said. Sometimes an anatomic problem could be degrading images. A patient may have hidden macular problems, anterior basement dystrophy, epithelial dystrophy, or cornea problems related to corneal guttata. Hopefully, a skilled surgeon will be able to catch these issues before implanting a multifocal, said Steven G. Safran, MD , Lawrenceville, NJ, USA. “They’re fair-weather lenses,” Dr. Safran said. “It’s like a hot air balloon ride. If the weather is wonderful, you can go up with caution. You don’t want to do it if it’s rainy or windy or miserable out. If you have any kind of pathology, a multifocal can be a deal breaker in terms of the patient’s happiness.” Specifically, Crystalens (Bausch + Lomb, Rochester, NY, USA) will sometimes have to be removed because of a bad configuration. Other indications for removal may be fibrosis, Z syndrome, or severe posterior vault, Dr. Safran said. “The main reason I have for removing multifocals is patient dissatisfaction with vision, particularly ghosting,” Dr. Safran added. Higher order aberrations cause patients to be dissatisfied with the quality of their vision, even when they’re 20/20, Dr. Tipperman said.