EyeWorld Asia-Pacific September 2015 Issue

September 2015 24 EWAP FEATURE Where do low add lenses fit into my practice? by Steven J. Dell, MD Multifocal IOLs with lower add powers provide surgeons with the ability to personalize outcomes for patients M any patients present with a request for good vision at all distances without spectacle dependence. Previous generations of multifocal IOLs usually left patients with good distance vision, good near vision, but less satisfactory intermediate vision. To achieve good vision at multiple ranges in the three principal areas people want to see—distance, intermediate, and near—I would employ a bit of monovision with bilateral accommodating lenses or mix accommodating and multifocal technologies together. Since the recent U.S. Food and Drug Administration (FDA) approval of two Tecnis Multifocal IOLs (Abbott Medical Optics, Abbott Park, Ill.) in lower add powers, surgeons now have the ability to personalize outcomes for patients based on their lifestyles and preference for near, intermediate, and distance vision. While more IOL options can make the surgeon’s job easier in some ways, it may complicate it in other ways. Managing patient expectations Patients who enter my office have a visual problem they desire to fix. Many are seeking a purely refractive remedy while others have quite significant cataracts. In either situation, most patients desire a greater range of vision without spectacles than they currently have. In this scenario, the cataract patient is an easier approach because overall vision quality improves just by removing the cataract. Additional spectacle independence is a bonus for this patient. However, the patient seeking a refractive surgical solution has higher expectations, and the challenge is to select a solution that preserves good visual quality while also increasing the quantity of what they can see without correction. The Tecnis Multifocal lenses offer these patients a quality of vision advantage over earlier multifocal lens options, and I feel comfortable using these in patients who start +2.75 Tecnis Multifocal lens Source: Steven J. Dell, MD Views from Asia-Paci c Sri GANESH, MD Chairman & MD Nethradhama Super Speciality Eye Hospital 256/14, Kanakapura Main Road, 7th Block Jayanagar, Bangalore – 560070, India Tel. no. +91-80-26088000 Fax no. +91-80-26633770 chairman@nethradhama.org T here is a plethora of options with regard to multifocal lenses for surgeons in the Asia-Pacific as compared to their U.S. counterparts which include trifocal IOLs and extended range of vision lenses (Tecnis Symfony). This makes selecting the right multifocal IOLs a little more difficult and challenging. Patient selection: It is very important to understand the needs of the patients and their personalities before selecting a multifocal IOL. Patients with significant cataract have a higher satisfaction level as they do not notice the reduced contrast with multifocal IOLs. Younger presbyopic patients who undergo clear lens extraction with multifocal IOLs take a longer time to adapt and get used to the reduced contrast, glare, and halos. It is best to avoid multifocal IOLs in very demanding patients who actively drive at night. A thorough preoperative evaluation including measuring angle kappa and alpha should be done and also a macular OCT before offering multifocal IOLs to patients. IOL selection: Patients with short arm length who do a lot of intensive reading and fine near work (knitting, sewing) need good reading vision at 35 cm and are best implanted with the Tecnis MF +4.0 D add. Also, myopic patients who need a higher add for comfortable reading should be offered this lens. Patients who are taller with a longer arm length and those who actively use computers, laptops, and tablets are very happy with the Tecnis MF +2.75 D add which gives excellent intermediate vision and also better quality of night vision. The Tecnis MF +3.25 D add provides intermediate and near vision at 40 cm which is quite balanced. The newer trifocal IOLs and the Tecnis Symfony provide a better range of focus for intermediate and near vision, but may require better lighting or weak reading glasses for small print. Editors’ note: Prof. Sri Ganesh is a consultant for and receives travel support from Abbott Medical Optics and Carl Zeiss Meditec (Jena, Germany).