EyeWorld Asia-Pacific June 2016 Issue

32 June 2016 EWAP CATARACT/IOL by Liz Hillman EyeWorld Staff Writer Cultural differences: How local lifestyle influences multifocal IOL selection How ophthalmologists and patients choose multifocal IOLs might depend on where they live and what they do W hen most people think about cultural differences, they think of food, art, music, and style. Multifocal IOLs are probably not very high on the list. Still, IOL selection is something Ronald Yeoh, MD , Singapore, said culture can certainly influence. “Different cultures place different emphases on lifestyle and work,” Dr. Yeoh said. “In one society, there may be a lot of emphasis on near work with the computer, tablet, and mobile phones dominating, and in another, it may be more of an outdoor life with little digital usage.” Factors like these influence how an ophthalmologist selects lens implants after cataract surgery. “It’s not always easy to pigeonhole multifocal lens usage based on culture or continent, but multifocal usage should be tailored to an individual’s lifestyle,” Dr. Yeoh said. With about 30% of his cataract surgery patients in 2014 receiving multifocal IOL implants—up to 50% if extended range of focus IOLs are included—Dr. Yeoh has embraced these implants since the early 2000s for patients wishing to be free from reading glasses. “I think that all patients with few exceptions desire spectacle close to the face,” he said. “Because of the Chinese characters being more complex, I might need a +4 D add for them to see well. But if the patients express that they drive at night and are concerned about halos, then I would use a much lower add.” Dr. Chang uses multifocal IOLs in more than 60% of his cataract patients. He tells his patients they will have halos and reassures them this usually improves within 3 months. “In many Asian major cities, most people do not drive and rarely go out at night, so halos in dark environments are not an issue,” he said. “Most of the time, they are indoors in bright light environments.” Dr. Chang said that most U.S. surgeons would likely choose a +3 D add because the population has a strong Caucasian majority who are, on average, taller with longer arms and are thus used to holding reading materials farther away. He added that people in the U.S. are also more likely to drive and would require a lower add for better intermediate vision to see the dashboard gauges. When a patient’s priority is distance vision, Dr. Yeoh presents a few options, but his “preferred choice” would be an extended range of vision IOL with a target refraction of about -0.5 D in each eye. Cesar Espiritu, MD, Philippines, Miguel Srur, MD , Chile, and Samaresh Srivastava, freedom so I consider every patient [a candidate] for a multifocal IOL, unless I choose not to recommend it because of the individual patient’s situation,” he said. In addition to proper patient selection based on their unique eye situation and taking into account their age, lifestyle, and work balance, considering any pervasive cultural factors is important, too, he said. “Written Chinese text may be very small and intricate and hence a full reading add is usually needed,” Dr. Yeoh said, offering an example of how culture can affect IOL selection. “Low add or normal monovision strategies may not be able to cope with the demands of reading Chinese text.” When such near vision is a high priority, Dr. Yeoh said he would choose a full-range diffractive IOL like the AcrySof IQ ReSTOR (Alcon, Fort Worth, Texas) or AcrySof IQ PanOptix trifocal IOL (Alcon). Dr. Yeoh said the ReSTOR +3 “hits a sweet spot” specifically for surgeons to “almost guarantee great reading vision, good distance vision, and fair intermediate vision.” The PanOptix, which earned the CE mark in 2015, is improved for intermediate vision and reduces dim light vision issues, Dr. Yeoh said. John Chang, MD , Hong Kong, brought up that even physical attributes common in a population can affect IOLs. “In Hong Kong where southern Chinese are generally shorter and have shorter arms, they are used to holding reading materials very continued on page 33