EyeWorld Asia-Pacific June 2016 Issue

34 June 2016 EWAP CATARACT/IOL by Vanessa Caceres EyeWorld Contributing Writer Pinpointing the best patients for multifocal IOLs … and the best IOLs for those patients IOL technology and patient selection evolve T he factors that surgeons consider when deciding who is the best multifocal intraocular lens (MFIOL) candidate have evolved over the past 10 years. At the same time, there are some tried-and-true principles surgeons use to best match the technology with the right patient. A first step used by Samuel Masket, MD , clinical professor of ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, is to make sure that both patients and surgeons understand what MFIOLs can—and cannot—do. “With any strategy we use to reduce spectacle independence after surgery, there’s patients referred from others who have MFIOLs and are not doing well because of contrast sensitivity issues due to glaucoma or other optic nerve diseases. • -aculopathy !ny form of macular disease that contraindicates MFIOLs, in his view. • Psychopathy 4his covers the gamut of patients who are too demanding, not willing to understand limitations, and are fixated on minor details. always a compromise in quality of vision,” he said. However, it’s helpful that some of the newer IOL technology has improved quality of vision, he added. One characteristic that surgeons consider before MFIOL use is occupation. For example, a person who spends his or her life at a desktop computer may fall within the weak spot of MFIOLs, Dr. Masket said. When considering MFIOL use, Dr. Masket prefers to avoid patients with what he calls “the opathies,” which cover the following: • +eratopathy 4his can be anterior, such as dry eye or epithelial basement membrane dystrophy, or posterior, such as Fuchs’ dystrophy. “All of these reduce image quality,” he said. • Pupillopathy 4his refers to when the pupil is too small or too large, varying with the optic design. • :onulopathy hIf there is a problem with weak zonules, the lens may be unstable over time,” Dr. Masket said. • /ptic neuropathy $r Masket has seen a few AT A GLANCE • 1aUJeOU TeleDUJoO for .'*0-T IaT eWolWed aT leOTeT IaWe DIaOged. • 0DVlar àOdJOgT QreWJoVT refraDUJWe TVrgery oDDVQaUJoO aOd QTyDIologJDal faDUorT all Qlay a role JO .'*0- QaUJeOU TeleDUJoO. • " loOger QerJod CeUweeO àrTU- aOd TeDoOd-eye TVrgery DaO IelQ TVrgeoOT aTTeTT wIere a QaUJeOU T refraDUJoO TeUUleT aOd gaVgeT UIe QaUJeOU T oQJOJoO of .'*0-T. • 'eNUoTeDoOd laTer UeDIOology dVrJOg .'*0- JNQlaOUaUJoO Nay Ce NoTU CeOeàDJal for aTUJgNaUJTN. Dr. Masket recommends avoiding patients with “the opathies” for multifocal success. Source: Samuel Masket, MD