EyeWorld Asia-Pacific June 2015 Issue

14 June 2015 EWAP FEATURE Views from Asia-Pacific CHOONG Yean Yaw, MD KPJ Pusat Pakarmata Centre for Sight 1-1, Jalan SS23/15, Taman Sea, 47400 P. Jaya, Selangor, Malaysia yeanyaw@gmail.com M alaysian ophthalmologists have been spoilt with numerous choices for multifocal and multifocal toric implants for many years. Many surgeons in Malaysia have access to the various model of multifocal implants from Alcon, AMO, Zeiss, Oculentis, Fine Vision, and Medicontour. This gives an advantage to surgeons to choose the right lens to meet patients’ expectations. If we are able to help patients be glasses independent most of the time after cataract surgery, we should explore and inform patients on the availability of multifocal implants. It is, of course, of utmost importance to choose the right patient with realistic expectations. In my experience, well informed patients with realistic expectations are pleased with the results most of the time if the outcome meets these two criteria: 1. Minimal refractive error and 2. Meet the patients’ near expectations. Patients will never be happy if the outcome is not close to plano. These patients can’t see near or far well without glasses. Patients will not be happy if they can’t see near well even if they can see far well or have no symptoms of glare and haloes. The reason patients pay extra for the implant is to be able to see near. So, choosing the right implant is critical. Some implants give very good near vision, even in dim environments, but poor intermediate vision. Some implants give good intermediate vision but not so good near vision and even poorer near vision if light is insufficient. Some implants give good near and intermediate range of vision but have a higher incidence of glares and haloes. I do mix and match diffractive implants if patients are not too satisfied with the first surgery. This combination of implants make the patients happier almost all the time. None of my patients ever see a significant difference of vision between the eyes. As for glares and haloes, this is usually not the patients’ complaints in my experience because if they are worried about these symptoms during preoperative counseling, they will be excluded from multifocal implants. Many of my patients do experience symptoms of glares and haloes, this includes my wife who had both eyes implanted with trifocal implants. However, they are still happy patients because they are glasses-free almost all the time and they accepted the tradeoff of glares and haloes at night. My wife is very proud and happy to assist me in filling up all the immigration forms, going through all the bills when we travel. She has even advised me to go for the surgery with the same implant. Editors’ note: Dr. Choong has no financial interests related to his comments. Kazuno NEGISHI, MD Associate Professor, Department of Ophthalmology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo 1608582, Japan Tel. no. +81333531211 Fax no. +81333598302 fwic7788@mb.infoweb.ne.jp A long with progressive aging of the population and increasing life expectancy in developed countries, the numbers of people with presbyopia and cataracts also will increase. Because today’s cataract patients are better educated and relatively more secure financially than younger patients, they are unwilling to compromise lifestyle to age-related visual deterioration and are aware of their expanding options. As mentioned in the article, new multifocal and presbyopia-correcting intraocular lenses (IOLs) have been launched recently. Toric multifoal IOLs allow physicians to loosen the astigmatism restriction, and low-add versions of multifocal IOLs broaden the indication for patients who demand sharper distance vision. In addition, conventional multifocal, accommodating, trifocal, and several types of refractive multifocal IOLs are available commercially. By choosing IOLs from these various options or combining different type of IOLs (the so-called “mix-and-match method”), we can now offer better options according to patients’ lifestyles. I agree with the comments that a healthy retina and personality are the major factors in determining who is a good candidate for a multifocal IOL. The patient satisfaction rate with multifocal IOLs is very high if the proper indications are followed. For example, in our clinic over 95% of patients were satisfied with the results of multifocal IOL implantation. However, multifocal IOLs work on the principle of simultaneous vision; one image is in focus while the out-of-focus image is suppressed. Therefore, photic phenomena, decreased contrast sensitivity, and failed neural adaptation are still inevitable potential problems that are correlated directly with safety and satisfaction. The new extended range of vision IOL, the Tecnis Symfony, is a promising option that resolves these problems. Dr. Koch referred to the possibility of micro-monovision with the Symfony. Considering the similar recent trend to increased depth of field in presbyopic correction by LASIK, this may indicate the future direction of the presbyopia correction with higher safety. Editors’ note: Dr. Negishi has no financial interests related to her comments. Multifocal - from page 12