EyeWorld Asia-Pacific June 2014 Issue

44 EWAP CAtArACt/IOL Pseudophakic dysphotopsia June 2014 have the capacity to understand and appreciate their performance expectations. Surgical pearls offered Among the surgical steps likely to improve clinical outcomes for multifocal recipients, Dr. Davison said, is the use of femtosecond laser cataract surgery. Specifically, femtosecond systems can provide more predictable and precise transverse arcuate keratotomy (TAK) to reduce astigmatism in more potential multifocal recipients. The ability of femtosecond lasers to treat up to 1.5 D of keratometric astigmatism essentially doubles the potential recipients of multifocal lenses, he said. Additionally, the femtosecond laser-provided capsulotomies have enabled improved performance for all types of lenses. However, there are no apparent benefits for helping the lens find the best position within the capsular bag for centration. “You can’t tell exactly where the lens is going to sit,” Dr. Davison said. “All you can do is dial it in and put it where you think is the best orientation at the time of surgery.” “The performance of multifocal IOLs is very susceptible to the effects of residual refractive error in either defocus or astigmatism,” said Dr. Pepose. “It is very important to achieve a postoperative emmetropic outcome, which at times requires a laser vision enhancement.” He avoids Tecnis multifocal IOLs in patients with larger pupils due to previous research indicating worse intermediate vision among that group. 2 The Crystalens AO Preparation - from page 43 MORIA S.A. 15, rue Georges Besse 92160 Antony FRANCE Phone: +33 (0) 1 46 74 46 74 - Fax: +33 (0) 1 46 74 46 70 moria@moria-int.com - www.moria-surgical.com THE MORIA OPTION FOR SBK Make your own comparisons between the One Use- Plus and a femtosecond laser in terms of capital investment, disposables per patient, and annual maintenance. www.moria-surgical.com Think Thin Thin, 100-micron, planar flaps Accuracy and predictability equivalent to Femto-SBK Smoother stromal bed No femto-complications … At a fraction of the cost (Bausch + Lomb, Rochester, NY, U.S.) has superior intermediate vision, although the near point is less, he said. Diffractive IOLs with add powers less than 3.0 are now undergoing clinical trials and may allow surgeons to further customize the patient’s intermediate vision. In the meantime, Dr. Pepose urged meticulous cortical cleanup and removal of all of the viscoelastic beneath the IOL. Additionally, he tries to decenter multifocal IOLs slightly nasally in the capsular bag in an effort to be more closely aligned to the visual axis. Other surgical interventions to improve the postop outcomes and reduce the occurrence of blurred vision or dysphotopsias include aggressively treating dry eye and any posterior capsular opacification. EWAP references 1. Prakash G, Prakash DR, Agarwal A, et al. Predictive factor and kappa angle analysis for visual satisfaction with multifocal IOL implantation. Eye . 2011;25:1187-1193. 2. Packer M, Chu RY, Waltz KL, et al. Evaluation of the aspheric Tecnis multi- focal intraocular lens: One-year results from the first cohort of the Food and Drug Administration clinical trial. Am J Ophthalmol . 2010:149:577-584 Editors’ note: Dr. Pepose has financial interests with Abbott Medical Optics, Bausch + Lomb, and Clarity Medical Systems (Pleasanton, Calif., U.S.). Dr. Davison had no financial interests related to this article. Contact information Pepose: jpepose@peposevision.com Davison: jdavison@wolfeclinic.com