EyeWorld Asia-Pacific September 2015 Issue

60 EWAP NEWS & OPINION September 2015 leave his patient sighted for years to come. “I know the patient will see tomorrow and for many years,” Dr. Ruit said. He was speaking on “The Role of SICS [small incision cataract surgery] in Modern Ophthalmology.” Earlier this meeting, Dr. Ruit had conducted a MasterClass on manual small incision catarct surgery (MSICS). During the course, he emphasized the value of the procedure particularly for addressing the massive cataract backlog at the community level. He also advocated making MSICS and similar non-phaco techniques an essential part of resident training as the procedure teaches surgeons particular skills they can use to manage complications encountered at the operating table. He repeated those points at yesterday’s symposium. “More than half—that’s an understatement—of cataract surgery in the world is being performed with non-phaco surgery,” he said. “There is still a role for non-phaco surgery.”Dr. Ruit said that while the cataract discourse at ophthalmology meetings tends to focus almost exclusively on phacoemulsification and expensive cutting-edge technologies such as femtosecond lasers, ophthalmic surgeons should not overlook such non-phaco techniques that are essential at the community level. This is not to dismiss phacoemulsification offhand—Dr. Ruit admitted that they are also looking into ways of bringing phaco down to the community level. The phaco needs to become available at low cost while retaining good quality. He said this would require the phaco machine equivalent of a laptop— user friendly, with lower-cost consumables. Bringing phaco to communities would also require intensive and standardized training programs; however, these would have the potential of serving a large target group. The symposium was co-hosted by the Chinese Cataract Society. ‘Close Encounters’ in presbyopia In the APACRS symposium co-hosted by the Philippine Society of Cataract & Refractive Surgery , presbyopia was the major topic. Kezuno Negishi, MD , Tokyo, Japan, presented on considering refractive and diffractive multifocal IOLs. Multifocal lenses have become widely accepted, she said. Dr. Negishi discussed a case series of 50 eyes where the multifocal IOL had been explanted. The multicenter study looked at 50 eyes of 37 patients who underwent explantation of a multifocal IOL and implantation of another IOL at 10 major medical institutions in Japan between January 2005 and December 2012. The data from this study indicated that 84% of the explanted IOLs were diffractive types. Additionally, it was shown that a decrease in contrast sensitivity was a major issue for these patients. To resolve this, there are new categories of IOLs for improved near performance. They include low-add diffractive, refractive rotational asymmetry, and extended depth of focus. Dr. Negishi also discussed some specific new IOLs, including the LENTIS Mplus (Oculentis GmbH, Berlin, Germany). Diffractive multifocal IOLs have captured the largest share of the IOL market, she said. “However, decreased contrast sensitivity is a major issue associated with this type of IOL.” The visual and refractive outcomes were excellent and stable up to 1 year after cataract surgery with implantation of refractive segmented multifocal IOLs with and without a toric component, she said. “The refractive segmented multifocal IOL is a good option for correcting presbyopia after cataract surgery because both the visual and refractive outcomes and the contrast sensitivity were excellent after implantation of this IOL,” Dr. Negishi concluded. Benjamin Cabrera, MD , Makati City, Philippines, presented on the topic of unhappy multifocal IOL patients. In order to have happy patients with multifocal IOL implantation, Dr. Cabrera highlighted several key points. His recommendations included considerations for the cornea, CME, the capsule, cylinder and residuals, centration of the IOL, and the circumference, among other factors. He also added that there are “4 C’s” of being proactive, which include chair time and counseling, choosing patients well, paying attention to the cornea surface, and conducting your “best surgery.” The chair time and counseling both have a lot to do with direct relationship to the patient, he said. It’s important to discuss a number of different topics with the patient prior to surgery, particularly the neural adaptability that will need to occur when the patient adjusts to their multifocal lens. Dr. Cabrera said that he has noticed that the younger the patient, the more easily they can adapt. To explain this change to older patients, he said he will explain it as going back to similar vision to what they had in their early 40s. There’s so many diagnostics Live reports - from page 59