EyeWorld Asia-Pacific June 2020 Issue

CORNEA 40 EWAP JUNE 2020 deliberately made him into a +9.00 hyperope, which took him from 20/200 best-corrected to +9.00 20/40. The second step was cataract surgery using a high-power IOL matched to the induced spherical aberration. This took him from +9.00 20/40 to +0.50 sphere for 20/40+. Dr. Schoenberg also highlighted the possibility of corneal haze. When he performs a substantial ablation, he uses mitomycin-C (MMC) and a longer exposure than he would normally use in a routine refractive case. He uses MMC 0.02% for 30 seconds. He also does an extended steroid taper, typically prednisolone or loteprednol four times a day for a month. He will taper slowly in a 2-week increment, then use a low-potency steroid for a few months after the taper of the steroid. He also recommends that patients take vitamin C ÃÕ««i“i˜Ìà vœÀ ̅i wÀÃÌ viÜ months and use sunglasses when outdoors. Haze remains a risk with large treatments, but these measures tend to minimize that risk, he said. EWAP Editors’ note: Dr. Hardten is in practice with Minnesota Eye Consultants, Minneapolis, Minnesota. Dr. Rapuana is in practice at Wills Eye Hospital, Philadelphia, Pennsylvania. Dr. Schoenberg is in practice with George Eye Partners, Woodstock, Georgia. None of the doctors had relevant disclosures. Outcomes with EDOF – from page 34 tolerate the distance vision, then based on this experience, he would decide what to put in the other eye. Now, most of the time, Dr. Donnenfeld said he puts the EDOF lens in ̅i `œ“ˆ˜>˜Ì iÞi wÀÃÌ >˜` ˆÃ comfortable that the patient is going to be happy with the distance vision. For the nondominant eye, he then decides whether to give the patient the same lens or try something else. “If they’re not happy, I have the opportunity to either do mini-monovision like we did in the study or add a higher multifocal in the nondominant eye,” he said, adding that both techniques work effectively. Dr. Donnenfeld always talks to presbyopic patients about the quality of vision that they can expect with EDOF lenses, if they are candidates. “I tell them that the quality of vision with an EDOF lens is comparable to a monofocal lens,” he said. Such lenses have negative spherical aberration to correct the natural spherical aberration. Also, this lens is a diffractive one, both at near and at distance, unlike other lenses that are only diffractive at near. “Because it’s a diffractive lens at distance, it corrects chromatic aberrations as well as spherical aberration,” Dr. Donnenfeld said. For patients who want the best quality of vision possible and who don’t mind wearing reading glasses, Dr. Donnenfeld still thinks that traditional monovision IOL techniques do well. But there is a downside to the –1.50 difference between the eyes when using this approach. “The problem is that their distance vision is so compromised by the monovision that they lose the depth of focus,” Dr. Donnenfeld said. “They lose a lot of quality of vision and have a lot harder time judging distance in front of them.” He views the mini-monovision approach as much safer. Other combinations with the EDOF lens are being studied. “Kerry Solomon, MD, recently presented a paper looking at the EDOF lens in the dominant eye and a +3.25 multifocal lens in the nondominant eye, and there were good results with that,” Dr. Donnenfeld said. EWAP Reference 1. Sandoval HP, et al. Extended depth- of-focus toric intraocular lens targeted for binocular emmetropia or slight myopia in the nondominant eye: Visual and refractive clinical outcomes. J Cataract Refract Surg . 2019;45:1398– 1403. Editors’ note: Dr. Donnenfeld is in practice with Ophthalmic Consultants of Long Island, Garden City, New York. He declared relevant interests with Johnson & Johnson Vision.