EyeWorld Asia-Pacific September 2019 Issue

Pearls for cataract and refractive surgery Extending the range even further: The AT LARA family of EDOF IOLs Ashvin Agarwal, MD , Chennai, India, introduced ZEISS’s new IOL technology, which “basically brings the perfect balance in between hav- ing fewer side effects and the best spectacle independence” The AT LARA family of EDOF lenses have become one of the mainstays in Dr. Agarwal’s practice. These lenses, he said, “stay some- where in the middle of the range of genres from monofocals to multifo- cals” and bring “great vision at dis- tance and intermediate and relieves you from the tension of all the side effects existing in all higher-end premium lenses.” “This is something that is huge when it comes to patient satisfac- tion,” he added. “AT LARA features a diffrac- tive optical design with 2 power additions at intermediate and far intermediate distances: This ’light bridge’ optical design is balanced in a way such as to extending the depth of focus and create a contin- uous range of sharp vision from far to intermediate distances.” It uses ZEISS’s patented smooth microphase (SMP) technology that does away with the sharp edges that cause glare and halos in older EDOF and multifocal IOL designs. The AT LARA’s design also expands the range of focus beyond that of existing EDOF lenses as illustrated by its defocus curve and features a color-corrected optic design for correcting chromatic aberrations. Dr. Agarwal and his colleagues conducted a study on the different IOLs from monofocals to multifo- cals that they were using in their clinic, collecting data about all the complications and reports of problems patients encountered with each type of lens. The LARA, he said, fit right in the middle of the range with all the EDOF lenses, with simpler trifocals on the other extreme. Regarding the implantation technique, Dr. Agarwal has found the LARA has the best plate-haptic design going into the bag. “Usually with a plate-haptic design, I use more force, but with this design I’m not using as much force to push it in,” he said. The result is an effort- lessly well-centered lens at the end of each case. After the eight cases he had performed by the time of the user meeting, Dr. Agarwal found that aiming for a 0.5-D myopic correc- tion provides great distance vision, losing only a little bit of near— which he indicated was true for any EDOF lens. For more near vision ac- cording to the patient’s preference, aim for a 1 D myopic shift. “The biggest advantage to me is the lack of halos,” he said. Ulti- mately, the AT LARA provides the Figure 1. Results of cataract surgery with multifocal IOL implantation post-SMILE. Source: Sri Ganesh, MD Sponsored by Carl Zeiss Meditec “ These lenses stay somewhere in the middle of the range of genres from monofocals to multifocals and bring great vision at distance and intermediate and relieves you from the tension of all the side effects existing in all higher-end premium lenses. ” Ashvin Agarwal, MD, Chennai, India widest range available of all EDOFs but with great balance between great vision and reduction in side effects.” Multifocals in post-SMILE cataract surgery Conventional wisdom dictates that multifocal IOLs are a less than ideal choice for less-than-pristine eyes. Sri Ganesh, MD , Bangalore, India, reported on t heir first case of a post-SMILE patient undergoing cataract surgery and receiving a multifocal IOL implant. The patient, a 50-year-old, underwent SMILE in 2013, when he had high myopia of –9.5 D, 0.5 D cyl in the right eye and –10 D, 0.5 D cyl in the left eye—almost at the upper limit of treatment. Post- SMILE results were very good, with the patient achieving an uncorrect- ed visual acuity of 6/6 in each eye; however, 5 years later he experi- enced diminished vision and poor night vision, subjectively unable to see well at distance. On examination, Dr. Ganesh noted grade 2 nuclear sclerosis in the right eye and grade 1 nuclear sclerosis in the left eye; an uncor- rected distance visual acuity (UDVA) of 6/24 –2.75 Sph –0.75 Cyl @ 30 improving to 6/9 in the right eye, 6/12 –2.0 Sph –0.75 Cyl @ 140 im- proving to 6/7.5 in the left eye. The patient posed Dr. Ganesh with a challenge—he did not want to wear glasses and specifically wanted multifocal IOLs. Pentacam studies showed that the SMILE outcome was retained and well-centered; meanwhile, a Holladay equivalent k-reading (EKR) detail report produced a single peak showing regular distribution of Ks. Zernike analysis was “not bad for someone who had high myopia since you expect induced aberra-