EyeWorld Asia-Pacific June 2017 Issue

64 EWAP DEVICES June 2017 by Rich Daly EyeWorld Contributing Writer Where extended depth of focus IOLs fit Surgeons shared what their experiences with EDOF lenses have taught them about patient selection, refractive targets, and mixing EDOF lenses with other types of IOLs S urgeons report an evolving view of the best uses for extended depth-of-focus (EDOF) IOLs, based on their experience with them. Several surgeons say EDOF IOLs have become a significant share of the lenses they implant. For example, Sumit “Sam” Garg, MD , associate professor of ophthalmology and vice chair of clinical ophthalmology, University of California Irvine School of Medicine, said EDOF IOLs now comprise 15–20% of his lens recipients. “This is higher than my multifocal use, predominantly because I can now correct higher levels of astigmatism concurrently given the toric platform of the Symfony lens (Abbott Medical Optics [AMO], Abbott Park, Illinois),” Dr. Garg said. Daniel Chang, MD , Empire Eye and Laser Center, Bakersfield, California, said his presbyopic IOL rate has probably doubled since the introduction of EDOF technology to about 30–40% of his total cases. “Some of that has grown Intraoperative appearance of ZLB00 (multifocal) vs. ZXR00 (Symfony). Note the differences in central zone size and number of rings. Source (all): Sumit “Sam” Garg, MD from the toric monofocals that I was using,” Dr. Chang said. “Most patients with astigmatism correction are now receiving toric EDOF IOLs.” Steven Dell, MD , Dell Laser Consultants, Austin, Texas, said mostly all his practice’s toric IOLs are EDOF lenses at this point. “I still see a large role for multifocal IOLs,” Dr. Dell said. Patient selection Such broad use of EDOF technology stems from surgeons’ views of the ideal recipients for such IOLs. Bennett Walton, MD , Slade & Baker Vision, Houston, said he views the ideal EDOF patient as someone who wants vision at multiple distances, prioritizes distance over near, and who will not mind the optical effects of EDOF lenses. “The difference is a subtle one between the ideal EDOF patient and the ideal multifocal patient, and that’s the relative importance of distance versus near vision,” Dr. Walton said. “I have found the EDOF lens to excel at distance even more than the latest multifocals. Even when EDOF patients test J1 or J2 in clinic, they occasionally state a preference for readers with prolonged reading. The EDOF has been more forgiving of residual refractive error and low irregular astigmatism, and the release of the toric version plays a large role in the usefulness, too.”