EyeWorld Asia-Pacific September 2013 Issue

50 EWAP rEfrActivE Septemebr 2013 Customized - from page 49 spectacle-free method of achieving crisp near vision. He had no problems with his distance vision and wanted it to remain clear postoperatively. He underwent LAL bilateral implantation, after which he had an uncorrected distance visual acuity of 20/30 in his right eye, 20/25 in his left eye, and an uncorrected near visual acuity of J6. His right eye was adjusted for distance vision and after two adjustments and two lock-ins, his distance visual acuity improved to 20/15. His left eye received a CNA2 adjustment and after three total adjustments and two lock- ins, his distance vision improved to 20/20 and he had a near vision of J2. Binocularly he reported clear spectacle-free vision at all distances and was very satisfied with his outcome. Adjustable monovision The flexibility offered by the LAL means that CNA is not the only method by which near vision correction can be achieved. As a monofocal lens, the LAL is designed to be fixed for clear vision at a single distance. However, as lens power can be altered after implantation, adjustable monovision is an additional option with which patients can simultaneously enhance both near and distance vision. To obtain monovision, the dominant eye is implanted with a LAL, which is then fixed for emmetropia, while the nondominant eye is fixed for –1.25 D. Patients are given two postoperative weeks to adapt to seeing in this manner. If they appear tolerant of this method of seeing, their level of monovision is refined and the lens is locked in. However, if monovision is not tolerated, the lens in the nondominant eye can be adjusted to achieve emmetropia. In my personal experience, the asthenopia that is often experienced with monovision is less common with the LAL than conventional monofocal IOLs. This is most likely due to the increased depth of field offered by the lens in addition to the manner in which its design permits highly precise adjustment of inter-eye refractive differences. This ensures that patients are given a customized level of monovision that they can adapt to. case study Patient KLM, a 71-year-old male and retired sociologist, presented with presbyopia. He underwent LAL implantation with blended monovision. Prior to his first adjustment, he had a right eye uncorrected distance visual acuity (UDVA) of 20/25-2, left eye UDVA of 20/20, and an uncorrected near visual acuity (UNVA) of J5. His left eye was set at a target power of –0.50 D. After his first adjustment, UDVA improved to 20/15 in his right eye, 20/20 in his left eye, and his UNVA improved to J3. The target power for his left eye was adjusted to –0.75 at the second adjustment, after which his near vision improved to J2, and he reported that he could now see his computer screen perfectly. tomorrow’s presbyope Since the birth of presbyopia- correcting lenses, eye surgeons have been faced with a wide variety of IOLs to choose from. All promise perfect multi-distant vision, yet the majority fail to deliver because they remain incapable of preventing residual refractive error. Even the most advanced lens technology cannot overcome the fact that no two eyes will adapt to an implanted lens in the same manner. The LAL approach accepts that residual error will almost always occur and puts the focus on rectifying the problem when it does occur. In doing so, outcomes can be matched to the patient’s postoperative requirements, ensuring that satisfaction is always achieved. As the population ages and patient expectations continue to rise, it is inevitable that the need for customized presbyopic solutions will also increase. EWAP Editors’ note: Dr. Chayet is affiliated with the CODET Vision Institute, Tijuana, Mexico. Dr. Chayet has financial interests with Calhoun Vision. contact information chayet: arturo.chayet@codetvision.com OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 • Fax +852 2987 1090 www.oculus.de • info@oculus.hk OCULUS Pentacam ® HR The new Belin / Ambrosio Display III: Unique for Keratoconus and Ectasia Detection Based on Corneal Tomography Combination of 5 corneal elevation and pachy- metry parameters into one final overall index for quick visual inspection for quick decision making comprehensive but intuitive ONLY available for Pentacam ® ! database for hyperopic patients novel pachymetric parameter ARTmax • • • • •