EyeWorld Asia-Pacific June 2015 Issue

June 2015 22 EWAP FEATURE Punctate corneal staining in a patient post-multifocal IOL Meibomian gland dysfunction with eyelid margin telangiectasias. Issues such as these can affect the outcomes of presbyopic IOL patients. Source (all): Preeya Gupta, MD Managing patients with presbyopic IOL complications by Ellen Stodola EyeWorld Staff Writer AT A GLANCE • Presbyopic IOLs each have their own set of potential complications for patients. • Managing the ocular surface prior to implanting these IOLs is critically important because poor ocular health can cause inaccurate measurements and poor vision quality, among other problems. • Explanting these IOLs is possible, but the physician should carefully consider all options before making that decision. It’s important for surgeons to discuss and appropriately handle complications A ccommodating, multifocal, extended depth of focus, and the first extended range of vision IOLs are options for presbyopic patients, but each of these technologies comes with its own set of concerns and specifications. Patients should be carefully selected prior to surgery for best outcomes, while also being made aware of complications that could arise. Preeya Gupta, MD , Durham, NC, Steven Dell, MD , Austin, Texas, and Eric Donnenfeld, MD , Rockville Centre, NY, discussed different types of IOLs and how to handle possible complications in these patients. “I think the most common reasons that patients are unhappy after these lenses is residual refractive error, dry eye, and not having proper expectations,” Dr. Gupta said. “The best way to avoid any of these is to do a very thorough preoperative assessment.” In addition to a thorough clinical examination and obtaining refractive data, it’s important to look for dry eye symptoms. She is particularly aggressive about addressing this problem before surgery because it can impact the biometry and surgical outcome, as well as the patient’s quality of vision. Dr. Gupta thinks it is also important to preoperatively anticipate any residual refractive error. This can be difficult to do, but there are steps surgeons can take preoperatively such as looking at the amount of corneal astigmatism and having a plan for managing that, she said. “In terms of patient candidacy, some practices will use a questionnaire to identify patients’ goals,” she said. “I think that works well but you still need to talk to your patients so they understand that multifocal and presbyopia- correcting IOLs are excellent technology, but they do have their limitations. Aligning expectations is key.” Potential complications The complications seen with the different IOLs vary, Dr. Dell said. As extended depth of focus and the first extended range of vision IOLs are not available in the U.S., the lack of clinical experience here with these lenses also has to be considered. However, those doctors working with extended depth of focus lenses outside the U.S. have reported distance quality similar to a monofocal IOL, with an expanded range of good intermediate vision to a functional level without the symptoms that would normally be associated with multifocality, Dr. Dell said. “Accommodating lenses have very good distance quality vision, equal to a monofocal optic,” he said. They also provide good intermediate vision but do not offer the same level of near vision as a multifocal. The challenge with accommodating lenses is that they are sensitive to capsulotomy size, Dr. Dell said. They cannot be used in the presence of an open posterior capsule or tear in the posterior capsule. Additionally, patients with zonular weakness may be less than ideal candidates. “Because these lenses are