EyeWorld Asia-Pacific June 2015 Issue

3 EWAP CONTENTS June 2015 Letter from the Editor Dear Friends O ver the many years I have had the privilege of being the Editor of EyeWorld Asia-Pacific , the one topic that remains as relevant as ever is the options available to provide unaided near vision following cataract surgery. In this issue we cover the different intraocular lenses and strategies comprehensively. Multifocal IOLs are widely used and have been considerably refined since they were first introduced. Traditionally, the percentage of patients achieving total spectacle independence had been the primary criteria on which the success of a particular implant was judged but there now appears to be increasing recognition of the importance of intermediate vision and the recognition that the link between spectacle independence and patient satisfaction are not always intimately linked. Trifocal implants and low add diffractive bifocal implants sacrifice reading ability but address the deficiency of conventional diffractive bifocal intraocular lenses with regard to intermediate acuity. Similarly, extended depth of focus IOLs offer excellent intermediate acuity but often require the addition of a modest level of myopia in one eye similar to modest monovision to provide spectacle independence for reading. There is always a balance in how much total light energy can be split into multiple foci or extended with an extended depth of focus approach before there is an impact on the quality of vision and contrast sensitivity. Similarly reducing the number of diffractive rings does assist in reducing unwanted symptoms such as light scatter but it is not clear that one can achieve the superb quality of a monofocal lens with existing multifocal and extended depth of focus technology. Although our ability to achieve emmetropia following cataract surgery continues to improve, refraction change and the development of against-the-rule astigmatism is not unusual with the passage of time. Together with an inevitable decline in macula function, these factors can impact the efficacy of multifocal implants as patients age. Accommodative lenses remain seductive but despite some encouraging new technologies a predictable accommodative lens remains elusive. Modest monovision, which is personally my preferred approach, remains a practical solution and is widely practiced. Limiting defocus to approximately 1.25 D preserves stereoacuity and minimizes the asthenopia of traditional monovision resulting in a high level of patient satisfaction. The compromise with modest monovision is that spectacles are occasionally required for demanding near visual tasks but the ability to reverse the correction with spectacles at any time that it proves necessary to do so remains attractive. All these factors need to be taken into account when counseling patients and selecting the most appropriate intraocular lens to address the need for improved unaided near vision after cataract surgery. Although many of the currently available options discussed in this issue are similar to what has been published previously, it is encouraging to see refinements in existing technology as well as the availability of new intraocular lenses that were not available previously. I’m sure all the readers of this issue will find the discussions and opinions of expert surgeons, particularly from the Asia-Pacific region interesting and thought provoking. 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