EyeWorld Asia-Pacific June 2019 Issue

FEATURE ÓÈ EWAP JUNE 2019 «iÀviVÌÞ }œœ` V…œˆVi]»…i Ã>ˆ`° º ÕÌ ˆv ܓiœ˜i Ã>Þà ̅iÞ œÛi ÀivÀ>V̈Ûi ÃÕÀ}iÀÞ >˜` Ü>Å>««Þ >˜` Ü>˜Ì ̜ }iÌ Ì…>Ì L>VŽ] ̅>̽à > `ˆvviÀi˜Ì V…œˆVi] >˜` ÞœÕ V>˜ “>Ži ̅>Ì «iÀܘ…>««Þ] ̜œ°» Dr. Waltz noted that there are > ˜Õ“LiÀ œv ÌiV…˜ˆV> `iÌ>ˆÃ ̅i «…ÞÈVˆ>˜…>à ̜ Li >Ü>Ài œv vœÀ ̅iÃi «>̈i˜Ìð v ̅i «>̈i˜Ì …>Å>` «ÀˆœÀ ÀivÀ>V̈Ûi ÃÕÀ}iÀÞ] ̅i ˆŽiˆ…œœ` ̅>Ì ÞœÕ½Ài }œˆ˜} ̜ }iÌ > }œœ` ÀivÀ>V̈Ûi outcome with the initial result ˆÃ `iVÀi>Ãi`° *>ÀÌ œv ܅>Ì Ì…i surgeon has to understand is ܅>Ì Ì…i i˜…>˜Vi“i˜Ì ÃÌÀ>Ìi}Þ will be, he said, adding that the ÃÕÀ}iœ˜ ܅œ œ«iÀ>Ìià ˆ˜ˆÌˆ>Þ `œiØ½Ì ˜iViÃÃ>ÀˆÞ…>Ûi ̜ Li the one to do the enhancement, LÕÌ ˆÌ…>à ̜ Li >Û>ˆ>Li ̜ w˜i‡ tune the outcome. Diagnostics Dr. Baartman said that some œv ̅i ̅ˆ˜}Åi ÕÃià “œÃÌ vÀiµÕi˜ÌÞ >Ài ̜«œ}À>«…Þ >˜` Ü>ÛivÀœ˜Ì >LiÀÀœ“iÌÀÞ Ìœ iÛ>Õ>Ìi V>˜`ˆ`>VÞ vœÀ > `ˆvvÀ>V̈Ûi œ«ÌˆV° i Ṏˆâià ̅i "* ‡-V>˜ ˆ`iŽ] Ài“œ˜Ì] >ˆvœÀ˜ˆ>® >˜` «>Þà close attention to the anterior VœÀ˜i> Å>«i] œœŽˆ˜} vœÀ >Ài>à œv ˆÀÀi}Տ>ÀˆÌÞ Ì…>Ì “>Þ …>Ûi Lii˜ ̅i ÀiÃÕÌ œv i>ÀÞ ÌiV…˜œœ}Þ >L>̈œ˜ «>ÌÌiÀ˜Ã] >˜` ̅i }i˜iÀ> Èâi œv ̅i >L>̈œ˜ ✘i° º >Ãœ ÕÃi ̅i «œˆ˜Ì ëÀi>` v՘V̈œ˜ ̜ iÛ>Õ>Ìi ̅i «ÀiÃi˜Vi œv…ˆ}…iÀ œÀ`iÀ >LiÀÀ>̈œ˜Ã] ܅ˆV…Ì…ˆ˜Ž is important to understand «Àiœ«iÀ>̈ÛiÞ]»…i Ã>ˆ`° º/…iÃi VœÀ˜i>à œvÌi˜…>Ûi > LˆÌ “œÀi spherical aberration than the ˜œÀ“> VœÀ˜i>] LÕÌ «>ވ˜} >ÌÌi˜Ìˆœ˜ ̜ ̅i «ÀiÃi˜Vi œv other aberrations, such as coma, can help detect those patients with even small decentrations ˆ˜ >L>̈œ˜ ̅>Ì “>Þ ˆ“ˆÌ ̅i ÃÕVViÃà œv “Տ̈vœV> i˜Ãið» Dr. Baartman also uses the *i˜Ì>V>“ "VՏÕÃ] 7iÌâ>À] iÀ“>˜Þ®] ˜œÌ œ˜Þ vœÀ VœÀ˜i> power estimations but he is also «>ވ˜} >ÌÌi˜Ìˆœ˜ ̜ ̅i «œÃÌiÀˆœÀ VœÀ˜i> >˜` VœÀ˜i> ̅ˆVŽ˜iÃð À° 7>Ìâ Ã>ˆ` ̅>̅i w˜`à >…ˆ}…‡µÕ>ˆÌÞ Ìœ«œ}À>«…iÀ to be the biggest diagnostic …i« vœÀ…ˆ“° i Ã>ˆ` ̅>Ì ˆÌ½Ã ˆ“«œÀÌ>˜Ì ̜ Ž˜œÜ ˆv ̅i >L>̈œ˜ ˆÃ Vi˜ÌiÀi`] ˆv ̅iÀi >Ài >˜Þ >Ài>à œv >L>̈œ˜ ̅>Ì Üˆ V…>˜}i ̅i µÕ>ˆÌÞ œv ۈȜ˜] >˜` ܅>Ì Ì…i ë…iÀˆV> >LiÀÀ>̈œ˜ œv ̅i VœÀ˜i> ˆÃ° º ̽à ˆ“«œÀÌ>˜Ì ̜ understand that as people get older, their lens changes shape and their spherical aberration ÌÞ«ˆV>Þ }iÌà ܜÀÃi]»…i Ã>ˆ`° v ޜսÛi…>` «ÀˆœÀ ÃÕÀ}iÀÞ >˜` >Ã ÞœÕ }iÌ œ`iÀ] ë…iÀˆV> aberration gets worse. Who should not have a premium IOL /…iÀi >Ài ܓi w˜`ˆ˜}à ̅>Ì indicate a patient is not a good V>˜`ˆ`>Ìi vœÀ > «Ài“ˆÕ“ " ° À° >>À̓>˜ Ã>ˆ` ̅>Ì >˜Þ iۈ`i˜Vi œv `iVi˜ÌiÀi` >L>̈œ˜ œÀ «ÀiÃi˜Vi œv È}˜ˆwV>˜Ì ̜Ì> corneal higher order aberrations >Ài Ài` y>}ð While some patients are not }œœ` V>˜`ˆ`>Ìià vœÀ >`Û>˜Vi` ÌiV…˜œœ}Þ " Ã] ˆv ̅iÀi ˆÃ iۈ`i˜Vi œv > `iVi˜ÌiÀi` ablation or other topographic ˆÀÀi}Տ>ÀˆÌÞ >˜` ̅i «>̈i˜Ì ˆÃ interested, Dr. Baartman said …i Vœ˜Ãˆ`iÀà ÕȘ} ̜«œ}À>«…Þ‡ guided ablations to normalize ̅i VœÀ˜i> ÃÕÀv>Vi ̜ ˆ“«ÀœÛi ̅iˆÀ V>˜`ˆ`>VÞ vœÀ ̅i i˜Ãið º Ý>“ w˜`ˆ˜}à V>˜ V…>i˜}i œÕÀ >LˆˆÌÞ Ìœ ÕÃi >`Û>˜Vi` ÌiV…˜œœ}Þ i˜ÃiÃ] ÃÕV…>à «œœÀ ✘Տi ÃÕ««œÀÌ vÀœ“ *8 œÀ «ÀiÃi˜Vi œv Àï˜> «>̅œœ}Þ ˆŽi Ƃ ]»…i Ã>ˆ`° º `œ «>Þ attention to pupil size as well >˜` i“«…>Èâi ̅i «œÃÈLˆˆÌÞ œv «…œÌˆV «…i˜œ“i˜> ̜ ̅œÃi patients with larger mesopic «Õ«ˆ `ˆ>“iÌiÀð» Dr. Baartman said that it is also important to build a relationship with the patients and understand their desires, >à Üi >à ̅iˆÀ >Ì̈ÌÕ`ið º ̅ˆ˜Ž ̅œÃi «>̈i˜Ìà ܅œ…>Ûi > Ìi˜`i˜VÞ ÌœÜ>À` «iÀviV̈œ˜ˆÃ“ “>Þ ˜œÌ Li }Ài>Ì V>˜`ˆ`>ÌiÃ] >˜` “>Ži ÃÕÀi ̜ ëi˜` time discussing the possible `À>ÜL>VŽÃ œv ÕȘ} >`Û>˜Vi` œ«ÌˆVÃ]»…i Ã>ˆ`° º/…ˆÃ œvÌi˜ helps select those who would Li LœÌ…iÀi` LÞ Ãœ“i œv ̅œÃi `À>ÜL>VŽÃ] ÃÕV…>à «…œÌˆV phenomena and decreased Vœ˜ÌÀ>ÃÌ Ãi˜ÃˆÌˆÛˆÌÞ°» i added that to him, the most ˆ“«œÀÌ>˜Ì V…>À>VÌiÀˆÃ̈V œv > good candidate is one who has a genuine interest in as “ÕV…ëiVÌ>Vi vÀii`œ“ >à possible, coupled with a good ՘`iÀÃÌ>˜`ˆ˜} œv ̅i ÀivÀ>V̈Ûi V>Ì>À>VÌ œÕÀ˜iÞ° º/…i VœÀ˜i> ŜՏ`…>Ûi “ˆ˜ˆ“> ˆÀÀi}Տ>ÀˆÌÞ œ˜ ̅i >˜ÌiÀˆœÀ ÃÕÀv>Vi] Li vÀii œv È}˜ˆwV>˜Ì…ˆ}…iÀ œÀ`iÀ >LiÀÀ>̈œ˜Ã œ˜ Ü>ÛivÀœ˜Ì ÌiÃ̈˜}] >˜` > ˜œÀ“> «œÃÌiÀˆœÀ yœ>Ì ÜˆÌ… i˜œÕ}…ÀiÈ`Õ> ̈ÃÃÕi vœÀ > >ÃiÀ i˜…>˜Vi“i˜Ì]»…i Ã>ˆ`° Optimizing chance for success À° 7>Ìâ Ã>ˆ` ̅>Ì Ì…i wÀÃÌ Ì…ˆ˜} to consider is treating the ocular ÃÕÀv>Vi° *iœ«i ܅œ >Ài V>Ì>À>VÌ >}i œvÌi˜…>Ûi È}˜ˆwV>˜Ì œVՏ>À ÃÕÀv>Vi `ˆÃi>Ãi] >˜` “>˜Þ ̈“iÃ] this issue can be improved with >À̈wVˆ> Ìi>ÀÃ]…i Ã>ˆ`° “«ÀœÛˆ˜} ̅i œVՏ>À ÃÕÀv>Vi V>˜…i« get better preoperative “i>ÃÕÀi“i˜Ì] >˜` ޜս Li 6QRQITCRJ[ CPF CDGTTQOGVT[ QDVCKPGF HTQO VJG 12& 5ECP +++ QP C RCVKGPV YKVJ CP interest in spectacle independence after cataract surgery. She had a history of prior 24- YKVJ C OQFGTCVG COQWPV QH EQTPGCN JKIJGT QTFGT CDGTTCVKQPU EKTENGF KP VJG DQVVQO TKIJV DQZ 6JKU YCU VJG RCVKGPVoU FQOKPCPV G[G YJKEJ FKF YGNN YKVJ CP GZVGPFGF FGRVJ QH HQEWU +1. YKVJ PQ RNCPU HQT GPJCPEGOGPV CV VJKU VKOG -œÕÀVi\ À>˜`œ˜ >>À̓>˜]