EyeWorld Asia-Pacific September 2014 Issue

3 EWAP September 2014 Letter from the Editor Dear Friends C ataract and implant surgery in the modern age has become an extremely safe and predictable procedure. Patient expectations are high and improving refractive outcomes continues to demand our attention. In this issue of EyeWorld Asia-Pacific you will find several articles focusing on methods to improve predictability such as femtosecond cataract surgery and intraoperative aberrometry to improve outcomes with toric IOLs. The question, however, remains how to deal with residual refractive outcomes following surgery. This issue has become increasingly important with the concept of premium lens surgery and the promise of being spectacle independent following surgery. What was considered an acceptable refractive result a decade ago no longer holds true, when a patient has outlaid considerable expense for the promise of being spectacle independent following surgery. The issues of cost and the most effective methods to deal with residual refractive error are featured prominently in our current issue. Not all cataract surgeons have access to refractive lasers and may be reluctant to refer patients for further treatment. If patients have not been counseled appropriately about the possibility of requiring laser treatment after surgery, the issue of additional costs can be challenging. As surgeons we have several different options, including lens exchange and laser correction following cataract surgery. Lens exchange is usually reserved for unsatisfactory vision, particularly with multifocal implants, but could be considered in the presence of a large, unexpected refractive outcome, particularly if hyperopic. LASIK is attractive in that the visual recovery is so rapid and there is less discomfort associated with the procedure than surface ablation. Nevertheless, in the older age group with an increased risk of dry eye, surface ablation for a minor residual error is certainly attractive. The availability of lenses designed specifically for sulcus placement, piggybacked on an existing IOL offers another alternative. A secondary IOL can incorporate a toric element or even a multifocal element if desired by the patient. New intraocular lenses in which the optic can be modified either mechanically or adjusted with UV radiation and are now available. The concept of an adjustable IOL has been around for many years and studies now indicate that this is indeed a viable option. Technical issues such as the need to wear sunglasses before the lock down procedure still remain and one wonders whether 2 weeks is long enough for postop refraction to truly stabilize. Experimental work using other means to adjust the power of an IOL such as Femto energy are also feasible and the day may yet arrive where the postoperative refraction can be adjusted in a simple and effective fashion and can become a routine part of postoperative care. Until we reach that stage, I’m sure all our readers will agree that we should do our very best to refine our prediction of refractive outcome with improved formulae, greater precision in the surgery, and accurate alignment of toric IOLs. Our efforts continue to provide more predictable outcomes but it is gratifying to have available several approaches to correcting residual refractive error if required. Warmest regards Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India ANG Chong Lye, Singapore CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Choun-Ki JOO, Korea Hiroko BISSEN-MIYAJIMA, Japan ASIA-PACIFIC CHINA EDITION Editors-in-Chief ZHAO Jialiang ZHAO Kan Xing Deputy Editor HE Shouzhi Assistant Editor ZHOU Qi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN ASIA-PACIFIC KOREA EDITION Regional Editor-in-Chief Hungwon TCHAH Regional Managing Editor Chul Young CHOI Hungwon TCHAH, Korea John CHANG, Hong Kong Johan HUTAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Prin ROJANAPONGPUN, Thailand Ronald YEOH, Singapore S. NATARAJAN, India YAO Ke, China Y.C. LEE, Malaysia