EyeWorld Asia-Pacific June 2014 Issue

63 EWAP NEWS & OPINION June 2014 to us in the near to mid-future for cataract and/or clear lens extraction procedures,” he said. Opening presentation Dr. Barrett began the symposium with an overview of results of clear lens extraction, looking to answer the question of whether it is a mad, or illogical, idea to remove the natural crystalline lens without cataract formation solely for the correction of presbyopia. He said he wanted to examine why “not only industry but physicians in this environment of reduced reimbursement may be focused on this potentially large market.” A Google search of clear lens extraction for presbyopia yields a great deal of information about the procedure, he said, showing that it provides quality vision at all distances without spectacles and the “added inducement that you won’t develop cataracts.” However, searching for the published papers on the topic results in far fewer finds, and “you have to extract data regarding presbyopic corrections from publications on clear lens extraction for myopia or hyperopia.” “But if we do so, we can say that the unaided acuity looks pretty good, almost 100% 20/30 or J4 or better, but we see that there’s about a 10% loss of best corrected visual acuity,” Dr. Barrett said. “Approximately 89% are within +/–0.5 diopters of emmetropia with good predictability. But beyond those figures, we know that there are issues.” Those issues include waxy vision and halos, which can occur with the multifocal lenses often implanted in these procedures. Patient satisfaction can be adversely impacted in these cases. Dr. Barrett provided case results of patients who had consulted him for a second opinion in the last three months who were unhappy following clear lens extraction for reasons including waxy vision, scatter, halos, or dysphotopsia. “I think you have to advise patients that in the long term macula function may deteriorate, which it is likely to, and this could impact their acuity. Furthermore, even the long-term promise of not wearing glasses may be illusory because astigmatism is not static and does tend to progress to against-the-rule with time,” he said. Closing presentation Dr. Mehta closed the symposium with a frank discussion about premium IOLs. He said the lenses have been defined as premium for many reasons, including cost, but that the idea of an IOL being called “premium” and therefore part of a “coveted category” is a misnomer. He said that the quality of a lens is not determined by the cost, but the cost is rather driven by medical reimbursements. “The patient must believe … that doing better surgery, utilizing more advanced lenses and techniques, is what we call rational surgery, not premium,” Dr. Mehta said. “Let’s make our patient believe, that for us, she is premium, and her eyes deserve the best possible premium vision we can give her.” EWAP Editors’ note: The physicians quoted have no financial interests related to this article. Contact information Barrett: barrett@cyllene.uwa.edu.au Mehta: admin@mehtaeyeinstitute.com Schallhorn: scschallhorn@yahoo.com Graham BARRETT Warren HILL Roberto BELLUCCI Bob CIONNI CHAN Wing Kwong Rohit SHETTY Our expert panel will comment, criticize and discuss correct course of action to ensure precise refractive outcomes after cataract surgery.