EyeWorld Asia-Pacific September 2019 Issue

66 EWAP SEPTEMBER 2019 DEVICES Incorporating the Light Adjustable Lens into a practice by Michelle Stephenson EyeWorld Contributing Writer Contact information Berdahl: john.berdahl@ vancethompsonvision. com Lindstrom: rllindstrom@mneye.com Maloney: rm@maloneyvision.com Miller: kmiller@ucla.edu Waltz: kwaltz56@gmail.com This article originally appeared in the June 2019 issue of EyeWorld . It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU JGTG YKVJ RGTOKUUKQP HTQO VJG #5%45 Ophthalmic Services Corp. T …i ˆ}…Ì Ƃ`ÕÃÌ>Li i˜Ã Ƃ ] ,Ý-ˆ}…Ì®…>à been FDA approved for more than a year but has not yet come to the marketplace. Surgeons are anxiously awaiting its availability, as it will offer a new level of customization for cataract surgery patients. According to Richard ˆ˜`ÃÌÀœ“] ] ̅i Ƃ ܈ create a premium monovision V…>˜˜i° º/…i Ƃ ܈ >œÜ vœÀ premium monovision, which I think will be popular. In the U.S., approximately 25% of patients choose moderate monovision, >˜` ̅i Ƃ ܈ >œÜ ÃÕÀ}iœ˜Ã to hit the target exactly where the patient wants it,” he said. He said there will also be the opportunity for a select group of patients to achieve perfect distance vision as well. “If you’re an airline pilot, a golfer, or an elite athlete who is willing to pay extra to have perfect vision in both eyes, there will be that opportunity. I would rather not have to do a laser corneal refractive surgery procedure if I could do an adjustment in the intraocular i˜Ã]» À° ˆ˜`ÃÌÀœ“ Ã>ˆ`° Precise outcomes According to John Berdahl, ] ̅i Ƃ “>Žià ÛiÀÞ precise outcomes accessible to every surgeon. “We are not changing human tissue; we’re changing silicone, which is much more predictable. We can make changes after the eye has healed, so we won’t have surprises in effective lens position, in surgically induced astigmatism, or in posterior corneal astigmatism. The outcome will be primarily dictated by how good of a manifest refraction the surgeon can do,” he said. The other advantage is that patients will be able to see what ̅iˆÀ w˜> ۈÃÕ> ÀiÃÕÌ Üˆ Li before locking it in, Dr. Berdahl said. Incorporating the LAL According to Kevin Waltz, MD, it is important to prepare your ÃÌ>vv vœÀ ˆ˜VœÀ«œÀ>̈˜} ̅i Ƃ into your practice. “When you start talking about charging $3,000 per eye or more extra for surgery, the staff has to get comfortable with that because that’s a huge number for them,” he said. If you are planning to add Ƃ à ̜ ޜÕÀ >À“>“i˜Ì>ÀˆÕ“] À° Waltz recommended beginning to implant toric lenses now. “This gives you and your staff an entry point to get comfortable,” he said. "˜Vi ̅i i˜Ã ˆÃ >Û>ˆ>Li] ̅iÀi ܈ Li > ëiVˆwV «ÀœÌœVœ for training surgeons, said Kevin ° ˆiÀ] ° º ̽à > È}˜ˆwV>˜Ì commitment of time for surgeons who want to implant these lenses. Patients will get implanted, wear UV-protecting glasses for the next 3 to 3.5 weeks indoors and outdoors, then undergo one or two light adjustments, followed by one lock-in treatments. There are many patient visits,” he said. Dr. Miller said that in the Vˆ˜ˆV> ÌÀˆ>] Ƃ «>̈i˜Ìà ÜiÀi targeted for hyperopia so that they could be adjusted toward emmetropia. “It’s easier to adjust these lenses from the hyperopic direction because you’re treating the center of the lens with the ultraviolet light. It’s a little harder to treat from the myopic direction, where you have to treat the «iÀˆ«…iÀÞ œv ̅i i˜Ã° "˜i œv the most frustrating aspects of treating these patients is they have to dilate to larger than the diameter of the lens, which is È ““° 9œÕ “>Þ w˜` ̅>Ì >vÌiÀ a patient has been consistently dilated numerous times, he or she undergoes a sort of pupil dilation fatigue. For the last few treatments, the pupil may not dilate beyond the edge of the lens implant,” he said. Robert Maloney, MD, agreed with targeting for hyperopia. “We typically target between +0.50 and +0.75 in the distance eye. If we are doing monovision, we target about –1.50 in the near eye. The technology allows patients considering monovision to experience different amounts of anisometropia, after the cataracts have been removed, using trial frames or temporary contacts. It offers a level of customization that’s never been possible before,” Dr. Maloney said. Dr. Berdahl added, “It won’t replace every lens on the market, but I think it will be one of the most important tools in our toolkit of lenses to help achieve spectacle independence.” continued on page 68