EyeWorld Asia-Pacific June 2020 Issue

34 EWAP JUNE 2020 REFRACTIVE O ne of the downsides of extended depth of focus (EDOF) IOLs is that they don’t give completely spectacle-free near vision, but research has found a way around this. By using a slight monovision (nanovision), the distance and intermediate vision of EDOF lenses is maintained, while near vision is improved. 1 “The advantage of these lenses is that they provide, in my estimation, the best quality of vision at distance of any presbyopic IOL that gives mid- range or near vision,” said Eric Donnenfeld, MD. Dr. Donnenfeld and co- investigators researched the use of EDOF lenses where 0.5 D of monovision was left in the nondominant eye with the Tecnis Symfony Toric IOL (Johnson & Johnson Vision). “You get all the advantage of the Symfony lens at distance in the dominant eye, while you’re still getting 20/25 vision, and you’re getting the extra diopter of reading in the nondominant eye,” Dr. Donnenfeld said of this technique. Outcomes in this prospective case series indicated that 92% of eyes in the mini-monovision group had a mean refractive residual astigmatism of 0.5 D or lower, as did 95% of those targeted for emmetropia. At 4 m, those in the mini-monovision group had slightly worse uncorrected visual acuity in the one eye than those in the emmetropia group. However, with binocular uncorrected acuity, there was not a ÃÌ>̈Ã̈V>Þ È}˜ˆwV>˜Ì `ˆvviÀi˜Vi] Dr. Donnenfeld said. Meanwhile, at 40 cm the residual refractive error was 0.25 D for those in the mini-monovision group versus 0.34 D in the emmetropia group. “Patients got very good distance LÕÌ >Ãœ }œÌ È}˜ˆwV>˜ÌÞ LiÌÌiÀ reading by adding that 0.5 D of monovision in the nondominant eye,” he said. Dr. Donnenfeld actually changed his approach to presbyopia management with EDOF lenses because quality of vision has improved with this technology. Previously, he used to put the lens in the ˜œ˜`œ“ˆ˜>˜Ì iÞi wÀÃÌ Ìœ “>Ži sure that the patient would Outcomes with EDOF mini-monovision by Maxine Lipner EyeWorld Senior Contributing Writer Contact information Donnenfeld: ericdonnenfeld@gmail.com This article originally appeared in the March 2020 issue of EyeWorld . It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU here with permission from the ASCRS Ophthalmic Services Corp. Symfony IOL in place showing diffractive rings. Symfony Toric IOL in place with positioning markers at 180 degrees. Source (all): Eric Donnenfeld, MD continued on page 40