EyeWorld Asia-Pacific September 2017 Issue

to base his IOL choice on the latest IOL technology and high preci- sion biometry. “Trifocal IOLs and extended depth of focus IOLs have replaced bifocal technology. The limitations of bifocal IOLs include the very high patient sensitivity to more than ±0.5 D postoperative refractive error outcomes, which is a small amount of postopera- tive refractive error. Bifocal IOLs don’t provide intermediate vision. Trifocals are less sensitive to a small amount of postoperative refractive error, provide intermediate and distance vision, and are the best available near vision correction. It is up to eye surgeons to select the IOL for our patients because we understand which indications allow a smooth transition to presbyopic IOLs. The diffractive technology is the most important consideration. We get the best results by applying high standard biometry that gives us high precision results for the IOL calculation. We know eyes better than our patients.” Four-year results Dr. Piovella’s study included 111 eyes of 67 patients with a mean age of 67.17±11.46 years that underwent uncomplicated cataract surgery with phacoemulsification and trifo- cal IOL implantation. Preloaded IOLs were implanted using a BLUEMIXS 180 injector (Carl Zeiss Meditec) for a 2.4 corneal incision. Postoperatively, the following visual and refractive parameters were measured: distance vision at 5 m, near vision at 40 cm, and intermediate vision at 80 cm, corneal topography, aberrometry, contrast sensitivity, and defocus curve. Regular follow-up examina- tions were performed up to 4 years after surgery. Biometry was carried out with special attention to those patients with dry eye, to ensure precise measurements. Preoperatively, the mean distance uncorrected visual acuity (UCVA) was 20/125. At 4 years, dis- tance UCVA was 20/20, monocular and binocular uncorrected near visual acuity (UNVA) and uncor- rected intermediate visual acuity (UIVA) were 20/32. “After 4 years’ experience with trifocal IOLs, trifocal technology has been applied in 73% of the patients that underwent cataract surgery in our surgical center. Of these, 94% of eyes achieved post- operative refractive results within ±0.50 D spherical equivalent,” Dr. Piovella said. “The AT LISA tri 839MP provided good distance and near as well as intermediate visual acuity. This lens also provided a high quality of vision and remark- able diffractive efficacy, with a low impact on contrast sensitivity. Our patients have never reported night time driving difficulties, and in 4 years of experience, we never need- ed to explant a single lens. The AT LISA 839MP is our first choice IOL to correct presbyopia in cataract patients because of the excellent technology and outcomes. It is the bifocal IOL replacement.” EWAP Editors’ note: Dr. Webers has no financial interests related to his com- ments. Dr. Piovella has financial in- terests with Johnson & Johnson Vision (Santa Ana, California), AcuFocus (Ir- vine, California), Carl Zeiss Meditec, TearLab (San Diego), Beaver-Visitec International (Waltham, Massachu- setts), Ocular Therapeutix (Bedford, Massachusetts), and TearScience (Morrisville, North Carolina). Contact information Piovella: piovella@piovella.com Webers: Valentijn.webers@mumc.nl eyes. “The average in our practice is approximately 1.5 paper lengths, which corresponds to 16.5 inches,” Dr. Dell said. “This test has been performed on several hundred patients in our practice, and we have validated its function.” Practices can use a tablet- based or laptop-based version of the questionnaire with a cali- brated piece of string to determine reading distance. The updated questionnaire also mentions the possibility of starbursts and halos to accurately describe possible dys- photopsias from EDOF lenses. Questionnaire impacts Dr. Dell has found his ques- tionnaire quickly provides good information on the visual desires of patients, as well as important clues about their personalities. “Some patients simply refuse to fill out the questionnaire,” Dr. Dell said. “This is a warning sign.” Others will mark up the ques- tionnaire by writing in the mar- gins, replacing words, providing a detailed narrative of their visual woes, or changing their answers multiple times. When the questionnaire was validated by correlating results with postop patient satisfaction levels, patients’ self-described per- sonality assessments—on a scale of “easygoing” to “perfectionist”— stood out. “The least happy people post- operatively were those who rated their personality exactly in the middle of the scale,” Dr. Dell said. “When we consulted a psycholo- gist about the possible significance of this finding, it was suggested that this response indicated pas- sive-aggressive behavior and that the patient didn’t like the fact that they were being asked to complete a questionnaire.” The most helpful aspect of the questionnaire for Dr. Dell was its ability to quickly identify peo- ple who have no desire to achieve spectacle independence postop. “This information saves a lot of potentially wasted time,” Dr. Dell said. For patients, the questionnaire was most helpful in cementing in their minds that optical compro- mises from preop visual goals may be required. “By answering difficult ques- tions, they begin to realize that complete independence from glasses might carry with it a greater risk of dysphotopsias or other opti- cal compromises such as a loss of stereopsis,” Dr. Dell said. Dr. Braga-Mele said the Dell questionnaire is “very good” but that it doesn’t reduce the impor- tance of surgeons speaking with their patients and discussing their options. She has learned from experience that even working with the best practices and address- ing expectations can still lead to surprises. “Although I fully believe in spending chair time before sur- gery to minimize chair time after surgery, we need to be ready to address certain issues and walk patients through unmet expecta- tions if necessary,” Dr. Braga-Mele said. EWAP Editors’ note: Dr. Braga-Mele has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, California), and Johnson & Johnson Vision (Santa Ana, California). Dr. Dell has financial interests with Allergan and Johnson & Johnson Vi- sion. Contact information Braga-Mele: rbragamele@rogers.com Dell: steven@dellmd.com One way – from page 36 Cutting-edge technologies – from page 37 38 EWAP CATARACT/IOL September 2017