EyeWorld Asia-Pacific September 2020 Issue

26 EWAP SEPTEMBER 2020 CATARACT I n the modern era of cataract surgery, surgical approaches and options for IOLs have grown exponentially. Mirroring this growth, patient expectations for postoperative vision and spectacle independence are higher than ever before. Innovative IOL designs aim to accommodate these expectations with options ranging from traditional monofocal IOLs to premium lenses, including bifocal, trifocal, multifocal, and extended depth of focus IOLs. These premium lenses have been reported to deliver better uncorrected near vision and have allowed for a higher proportion of patients to achieve spectacle independence compared to monofocal IOLs. However, they carry a greater risk of unwanted visual phenomena in contrast to typical monofocal lenses. 1 Despite the increasing prevalence and versatility of premium IOLs, monofocal lenses remain the most common IOLs utilized in cataract surgery around the world. A drawback of bilateral monofocal IOLs is the requirement for spectacle correction to optimize vision at near or distance. This can be attributed to the loss of depth of focus (DOF) that occurs with intraocular lens implantation. Patients who want to minimize the use of glasses postoperatively may consider “mini-monovision,” where the surgeon targets the dominant eye for emmetropia and the non-dominant eye for mild myopia. 2 Patients with mini- monovision acquire an increased DOF at the cost of losing a degree of stereopsis. As a result, a portion of patients cannot overcome this discrepancy between postoperative focal points and require refractive correction via spectacles, contact lenses, or LASIK/ PRK. 3 As such, the majority of patients aim for equal refractive outcomes in both eyes. Cataract surgeons employing monofocal IOLs typically aim for emmetropia or mild myopia. The choice between these two refractive targets is often guided by the surgeon’s assumption, within the context of the patient’s refractive history, of what will provide the most functional postoperative vision. While some patients value hyperopic uncorrected visual acuity, an era of handheld technology places a premium on intermediate and near visual acuity for daily functioning. Identifying which refractive goal—emmetropia or mild myopia—can preserve the greatest depth of focus at intermediate and near focal points, without sacrificing sharpness of distance vision, remains a critical challenge in surgical planning for patients receiving bilateral monofocal IOLs. Study review The study by Vinciguerra et al. is a retrospective study of 60 patients who were recruited postoperatively after phacoemulsification with monofocal IOL implantation in both eyes. This study was conducted at a single center with all surgeries being performed by a single surgeon. Once recruited, the 60 patients were divided into Jeremy Jones, MD Director, Residency Program in Ophthalmology Emory Eye Center Atlanta, Georgia Review of ‘Comparison of visual performance and satisfaction with a bilateral emmetropic vs. a bilateral monofocal mild myopic target using a spherical intraocular lens’ by Matthew Floyd, MD, Jeremy Jones, MD, Rebecca Neustein, MD, Kenneth Price, MD, Gina Shetty, MD This article originally appeared in the June/July 2020 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Jones: jjones2@emory.edu From the Emory Eye Center (clockwise from top left): Kenneth Price, MD, Jeremy Jones, MD, Gina Shetty, MD, Rebecca Neustein, MD, and Matthew Floyd. Source: Emory Eye Center