EyeWorld Asia-Pacific June 2016 Issue

36 June 2016 EWAP CATARACT/IOL If it’s a routine case, Dr. Masket does not think it’s necessary. “I have very specific indications for the femtosecond laser. Those include people with dense cataracts, shallow chambers, compromised endothelium, zonular issues, or specific capsule issues,” he said. One area where Drs. Masket and Hamilton think the femtosecond laser may be of help is in treating astigmatism. “If the surgeon can be assured of a well- placed capsulotomy, then I’m not sure femtosecond capsulotomy is helpful. But if the surgeon isn’t comfortable with reproducible capsulotomy, I think having the laser is better,” Dr. Masket said. “I think I’m hitting my targets better than I would with manual astigmatic keratotomies, and that’s critical for multifocals in the U.S. since we currently have no access to toric multifocals,” Dr. Hamilton said. Ultimately, the benefit of the femtosecond laser during MFIOL procedures depends on the surgeon, Dr. Masket said. Dr. Lee does not believe that use of the femtosecond laser during cataract surgery in MFIOL patients makes a difference in outcomes. Incorporating low-add MFIOLs There’s one major cultural change in the past 10 years that’s pushed for some changes to MFIOLs: the incessant use of smartphones and other mobile devices, which prompt the need for more intermediate vision. “We now all live with smartphones at arm’s distance, for better or worse,” Dr. Masket said. “The companies have responded and made lenses with a closer approximation to the way we live.” The newer low-add IOLs available now in the U.S. include two from Abbott Medical Optics (+2.75 D and +3.25) and one from Alcon (Fort Worth, Texas; AcrySof IQ ReSTOR +2.5 D). For better intermediate vision with the Alcon low-add IOL, there is a trade-off with not as sharp near vision, Dr. Lee said. In fact, patients will need readers more for near tasks when using the Alcon low-add IOL. However, there’s a more continuous range of vision compared with older MFIOLs, and fewer patients should complain about halos, he added. Dr. Hamilton has been particularly pleased with his use of the :+" low add -&I/L (+2.75 D), achieving spectacle independence 70% of the time when he uses the low-add MFIOL in a bilateral fashion. He’s been using the lens a little over a year.” EWAP Editors’ note: Dr. Hamilton has financial interests with Alcon and Abbott Medical Optics. Dr. Masket has financial interests with Alcon. Dr. Lee has no financial interests related to his comments. Contact information Hamilton: hamilton@jsei.ucla.edu Lee: bryan@bryanlee.pro Masket: avcmasket@aol.com Pinpointing - from page 35