EyeWorld Asia-Pacific June 2018 issue

EWAP FEATURE 21 Where we stand with MFIOLs by Stefanie Petrou Binder, MD EyeWorld Contributing Writer AT A GLANCE • The lower add MFIOLs and EDOF IOLs are the best choices for consistent higher quality vision. • Photic phenomena among the current generation of MFIOLs are far less commonly experienced and less bothersome than in previous versions. • Blended vision and mini- monovision successfully combine IOLs to maximize the visual range. • The right IOL combinations can enhance vision and reduce visual side effects. The latest models of MFIOLs bring patients closer to a full range of vision with fewer photic phenomena T he aim and challenge of multifocal intraocu- lar lenses (MFIOL) is to provide clear vision to patients for a full range of dis- tances, from far to near. Physicians want to provide patients with the best possible vision, suited to their preferences and lifestyle, without compromising all that much on any one end of the spectrum. The evolution of multifocal lenses is ongoing and always improving, so it is important to keep abreast of what is new and how experienced surgeons are incorporating the latest devices into their practice. EyeWorld spoke with Tal Raviv, MD , associate clinical professor of ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine, New York, and Elizabeth Yeu, MD , Virginia Eye Consultants, Norfolk, Virginia, about which multifocal lenses they choose and why. Who are MFIOLs best suited for? The current generation of mul- tifocal IOLs, particularly the lower add versions, as well as the extended depth of focus (EDOF) IOLs, provides consistently higher quality vision than their predeces- sors. Toric multifocal and EDOF IOLs have expanded the inclusion criteria for whom physicians are able to offer presbyopia correction to, so more than ever, physicians have excellent choices to offer patients a fuller range of vision. Still, multifocal IOLs are not for everyone. According to Dr. Yeu, a good candidate needs to have some flexibility. “The right candidate for multifocal IOLs has healthy eyes and is motivated to have spectacle independence with realistic goals regarding potentially adjusting their arm span for the best vision. Someone interested in a MFIOL needs to understand that complete spectacle independence is unreal- istic,” she said. “Patients can have controlled mild dry eye disease, at worst, and no retinal or macular pathology.” Dr. Raviv agreed. “A healthy eye with good visual potential is the most important factor. Further- more, the patient should under- stand the benefits and limitations of multifocal technology. I explain that 100% spectacle independence may be impossible as well as de- scribe the possible photic phenom- enon associated with multifocals. The old warning about avoiding the exacting or type A engineering patients I find inaccurate, as they are usually the most aware of the IOL limitations and the limits of physics and optics when it comes to splitting light energy. Some- times the most laid back patient with the least understanding can be the most disappointed,” he said. Photic phenomena are far less frequent and bothersome than with early MFIOL versions, how- ever, they can still occur and war- rant mention. Dr. Raviv takes a lot of time in counseling his patients and educating them about poten- tial side effects before deciding if it is the right choice for them. “I discuss all the surgical options I deem appropriate to patients to meet their visual outcome desires, and that includes ways to man- age the ‘absolute presbyopia’ that bilateral plano targeted monofo- cal IOLs induce. I explain that presbyopia correcting IOLs such as MFIOL and EDOF can greatly im- prove spectacle independence, but they may have night time artifacts around point sources of light, and I describe those. I also explain that today’s fourth and fifth generation multifocals have far less aberra- tions than the earlier versions that gave the technology a rough start,” he said. Although patients need to be fully aware of the potential imper- fections of MFIOL vision, current ReSTOR +2.5 with ACTIVEFOCUS Source: Alcon continued on page 22 June 2018