EyeWorld Asia-Pacific December 2021 Issue

16 EWAP DECEMBER 2021 F our leaders in re- fractive and cata- ract surgery came together in an in- teractive APACRS webinar, moderated by Ronald Yeoh, MD, Singapore and Gra- ham Barrett, MD, Australia, on September 23, 2021 to present their clinical expe- rience and case scenarios on choosing the right intra- ocular lens (IOL) for their patients. There currently exists a plethora of available IOLs for patients today and the panel provided a guide to the thought process of choosing the right IOL for the right eye. Monofocal IOLs/ Monovision: Where are we today? Mun Wai Lee, MD, Malaysia Around the world, the use of advanced technology IOLs is low, and is even lower in Asia Pacific (APAC) countries. Although astig- matism prevalence in APAC countries is comparable to other regions of the world, only 2.7% of toric IOLs are implanted in patients com- pared to 7.2% in the United States and 30.4% in Austra- lia. Similar trends are seen with presbyopia correcting IOLs. Dr. Lee explained that some barriers to adoption of these IOLs are due to both surgeon and patient factors. Surgeons may have limited access to technology or lack of confidence in the tech- nology. Additionally, there may be increased costs with specific instrumentation as well as more complicated management of side effects. On the patient side, patients have no access or knowl- Horses for Courses: Using the Right IOL for the Right Eye edge about such IOL tech- nology nor are they willing to gamble on the risk of the side effects. Of the lenses that are im- planted in cataract surgery, 90% are monofocal IOLs, and they are the “bread and butter” of cataract surgery, says Dr. Lee. As the type of IOL material has changed from rigid to foldable over the past decades, surgeons have overcome a variety of side effects such as inflam- mation, calcification, and glistening. The Clareon ® IOL is a mono- focal IOL that was devel- oped with a hydrophobic acrylic material. The water content of the lens, when developed, was increased, though not to the point of becoming hydrophilic. Paired together with the innovative AutonoMe™ pre- loaded IOL delivery system, the Clareon ® IOL can be delivered in a very smooth manner during surgery. In Dr. Lee’s multi-center ret- rospective study, “Clinical Evaluation of a New Hydro- phobic Preloaded Intraocular Lens with a Novel Delivery System,” 1 his initial experi- ence with the Clareon ® IOL showed not only good visual outcomes but also good refractive predictability and stability along with good contrast sensitivity. Using the Clareon ® IOL with the AutonoMe™ delivery system was unique in that the deliv- ery system was easy to pre- pare with a minimal learning curve and an intuitive er- gonomic design. Although manually-loaded IOLs are very familiar to cataract sur- A majority of Malaysian surgeons prefer implantation with a single-handed push, preloaded IOL delivery system . geons, Dr. Lee believes that preloaded delivery systems are currently trending and will become the norm for a number of reasons. Be- cause preloaded systems are disposable, there is no additional IOL handling in the operating room, making surgical time more efficient. No IOL handling also means less risk of infection or dam- age to the IOL. In a personal audit of Dr. Lee’s own cataract surgery practice, he found that he was implanting monofocal IOLs about 60% of his time, while toric IOLs were im- planted 20% of the time and presbyopic IOLs and mono- vision surgery both made up 10% of his cataract sur- gery cases. Because Dr. Lee stands by his “bread and butter” of monofocal IOLs, he is confident that these IOLs provide a bigger “land- ing zone” while extending the range of vision to inter- mediate distance. 1. Lee MW et al. Clinical Eval- uation of a New Hydrophobic Preloaded Intraocular Lens with a Novel Delivery System. Paper presented at: APACRS 2021; 30-31 July 2021; Virtual. Toric IOLs: Importance, stability, and when to start using? Tae-Im Kim, MD, South Korea Refractive errors such as astigmatism, caused by an ir- regular anterior or posterior surface of the cornea or an uneven curvature of the lens or retina, result in undesir- able effects for patients such as eye strain and excessive squinting due to distortion in vision. Cataract surgery can remove lenticular astig- matism; however, remaining astigmatism is always a con- cern. In fact, the prevalence of corneal astigmatism over 1 diopter prior to cataract surgery is 36%. There have been many methods aiming to neutralize astigmatism during cataract surgery such as limbal relaxing incision, clear corneal incision arcuate keratotomy, excimer laser treatment, and toric IOL im- plantation. Data has shown that most cataract proce- dures have adopted the use of toric IOLs since 2011. Based on the European So- ciety of Cataract and Refrac- tive Surgeons (ESCRS) 2019 clinical trends survey results, there was a dramatic in-