EyeWorld Asia-Pacific June 2016 Issue

33 EWAP CATARACT/IOL June 2016 MD , India, all mentioned how general education and affordability of premium IOLs are also factors in multifocal lens selection. “I think that one of the important factors, if not the most important, is the level of education of the population,” said Dr. Espiritu, who implants multifocal IOLs in 60 to 80 of his cataract surgeries annually. “With this goes access to and increased use of technology, such as computers, mobile phones, and other handheld gadgets. Couple this with fingertip access (Internet and web) to information regarding one’s options for visual rehabilitation, and the patient inquiries and requests for multifocal vision would be high.” Dr. Srivastava said that while people in larger Indian cities are expecting more from their cataract surgeries, “compared to the Western world, there is still a large population who are not aware of the various IOL options or feel they do not qualify for spectacle independence,” he said. “Depending on the culture of the place, patients tend to accept ametropia after cataract surgery without complaining,” continued Dr. Srivastava, who implants multifocal IOLs in 10 to 15% of cataract surgery patients. “Further, education and general awareness about newer technologies and outcomes with these IOLs are often a limiting factor in the choice of multifocal IOLs.” Dr. Srur said that access to a specialist with expertise in the field is a determining factor for a successful surgery. “Unfortunately, these conditions do not always occur in Latin America, leading to an inadequate indication of a multifocal IOL and to the patient’s Views from Asia-Paci c LEE Mun Wai, MD Medical Director, Lee Eye Centre 44-46 Persiaran Greenhill, Ipoh, Perak 30450 Malaysia Tel. no. +605-2540095 Fax no. +605-2540273 munwai_lee@lec.com.my T he practice patterns of cataract surgeons around the world may differ depending on the patient population we serve and knowing that subtle yet signi cant differences will improve our chances of hitting the target with our patients. In my practice, I use multifocal IOLs (MFIOLs) in about 10–15% of my cataract patients. Everyone is given the option of having spectacle independence and should they opt for a monofocal IOL, I make it a point to remind them that looking at price tags or reading text messages will not be possible without glasses. This is an important point as there being a large proportion of myopes in my patient population, they are used to wearing glasses but often subconsciously perform a lot of near tasks without their glasses and having a monofocal IOL would mean that the reverse situation would be true after surgery. If spectacle independence is desired, then I would nd out what their predominant leisure activity is. If they love to read, it is important to know whether they read mainly Chinese text, as Chinese text with its many strokes is more challenging to read. It is also important to know if they predominantly read print material or use the computer, mobile devices (tablets or ebook readers) or smart phones as reading with a digital devices is often easier as contrast is better and the font size can be adjusted. In these avid readers, a diffractive multifocal IOL such as the Alcon ReSTOR (+3) works well in my experience. A +4 add MFIOL is possible but the increased glare and haloes would be a problem. If they prefer intermediate- or distance-dominant activities (e.g. pianists, chefs, artists, golfers), I have found the newer extended range of focus IOL such as the Abbott Symfony (Abbott Medical Optics, Abbott Park, Ill.) to be a great option. It provides good unaided intermediate and distance vision and by using a mini- monovision strategy (~ –1.00 D in the non-dominant eye), most of my patients are able to read N5 unaided as well. Furthermore, problems with glare, haloes, and contrast sensitivity are much fewer with this IOL. The world is now a global village and cataract surgeons will have to be mindful of these cultural differences in order to best serve our patients. I use a very simple algorithm ( gure) to guide me, but precise biometry, surgical technique, and continuous personal audit (of surgical outcomes) are all essential in achieving good outcomes with MFIOLs. Editors’ note: Dr. Lee declared no relevant nancial interests. dissatisfaction,” he said, adding that “informed consent is essential for patients, but unfortunately it’s not always offered.” While culture can affect IOL choice, some of these physicians said it might also influence new multifocal IOL design. “In an ideal world, a single multifocal IOL that works for everything would be fantastic, but that is unrealistic due to the limitations of IOL designs,” Dr. Yeoh said. “Already, we have a range of multifocal IOLs that cater to almost every lifestyle need. It’s up to surgeons to take the time to assess each patient, be familiar with the pros and cons of each lens design, and make his choice for the patient. “The challenge down the line is to provide a full range of vision from far to intermediate to near without compromise so that we don’t have to make these decisions,” he said. Dr. Srivastava said he envisions the future of multifocality will tend toward advanced accommodating lenses without loss of light for any focus. “Intraocular lenses that can mimic the natural accommodating human lens will hopefully replace the pseudoaccomodating type of multifocal lenses available today,” he said. EWAP Editors’ note: Dr. Yeoh and Dr. Srur have financial interests with Alcon and Abbott Medical Optics (Abbott Park, Ill.). Dr. Chang, Dr. Espiritu, and Dr. Srivastava have no financial interests related to their comments. Contact information Chang: johnchang@hksh.com Espiritu: espiritueyemd@mac.com Srivastava: samaresh@raghudeepeyeclinic.com Srur: msrura@gmail.com Yeoh: ersryeoh@gmail.com Cultural - from page 32 Dr. Lee uses an algorithm as a guide for IOL selection. Source: Lee Mun Wai, MD