EyeWorld Asia-Pacific June 2016 Issue

35 EWAP CATARACT/IOL June 2016 Dr. Masket always prefers to keep patient expectations in check by informing them that even in the U.S. Food and Drug Administration trials for MFIOLs, 6–7% of patients would choose not to have the same lenses again. Although D. Rex Hamilton, MD , health sciences clinical professor of ophthalmology, Stein Eye Institute, and director, UCLA Laser Refractive Center, Los Angeles, uses MFIOLs in many patients, he is still reluctant to use them in most post-refractive eyes. After myopic LASIK, for example, a patient’s spherical aberrations tend to be higher than normal, a feature that makes the eye less compatible with the multifocal optics. The optics in a post-radial keratotomy eye are typically not clean enough to be compatible with multifocal optics, he said. Bryan Lee, MD, JD , Altos Eye Physicians, Los Altos, Calif., also takes corneal aberrations into consideration. “If a patient has significant cylinder, I steer the conversation toward a toric IOL. However, even if the amount of cylinder isn’t that high, if patients have a lot of coma or other higher- order aberrations, I show them their scan and explain that a multifocal IOL is a bad choice for them,” Dr. Lee said. One previous concern with MFIOLs that Dr. Hamilton is less worried about now is nighttime glare and halos, as he finds the newest version of the Tecnis multifocal IOL (Abbott Medical Optics, Abbott Park, Ill.) has significantly less nighttime quality of vision issues. “I don’t get scared off by nighttime quality of vision issues anymore with the new low add power Tecnis multifocal IOLs,” he said. One eye or two? Surgeons must assess if a patient is best suited for bilateral use of the same MFIOL or the use of two different MFIOL technologies. Many have their personal preferences. When Dr. Hamilton finds a patient who is an MFIOL candidate, he explains that he will operate on one eye and then the other eye about 2 weeks later. He lets patients know that they may initially see halos at night, which he likens to seeing the frames of glasses when one gets a new pair. In other words, the halos may still be there, but the patient will ignore them over time. At 1 week after surgery in the first eye, Dr. Hamilton will then ask patients about their vision while using a computer and their vision while using a cell phone. If patients are pleased with their vision in both cases, he uses the same I/L in both eyes the :+" Tecnis multifocal IOL. If the patient needs a boost with near vision, he will use a higher add power lens in the second eye. In a study that Dr. Hamilton will report on at the 2016 !S#RS•!S/! Symposium Congress [ held in New Orleans last May – ed. ], he found the same uncorrected near visual acuity in patients who had bilateral implantation of the same IOL versus those with different IOLs The overlay from the Callisto markerless system helps with centration of the Tecnis ZKB00 low-add multifocal IOL. After the IOL is centered, curved intraocular scissors are used to resize and recenter the capsulorhexis on the new IOL position. Source (both): Bryan Lee, MD, JD when the decision to place same versus different was based on the computer/cell phone surveying after the first eye surgery. Dr. Masket supports using the same technology in both eyes if that is what best suits the patient. If he performs surgery in patients who have older IOL technology in one eye, he’ll use newer technology with a lower add in the second eye. Dr. Lee likes to start with the lowest-add multifocal in the first eye and then wait at least 3 weeks for the patient to stabilize from a refractive standpoint and see if the patient is plano. The longer time between eyes gives patients more time to make sure they like having a multifocal IOL and to decide if they want to increase the add for the second IOL. Weighing in on femtosecond laser use Femtosecond laser use in cataract surgery has been a hot topic the past few years, but do the bells and whistles of the laser actually make a difference in outcomes? continued on page 36