EyeWorld Asia-Pacific December 2021 Issue

REFRACTIVE 26 EWAP DECEMBER 2021 Dr. Donnenfeld said getting into toric " s first is a great way to enter the premium IOL space. Then he said to consider low-add EDOF lenses, describing them as having less risk of patient dissatisfaction. After these, he said he would start with trifocals because they give true spectacle independence. While these are high-reward lenses, he said surgeons need to pick ideal candidates. The low-hanging fruit when you’re starting in this space, Dr. Donnenfeld said, are hyperopic patients with a significant cataract. Dr. Williamson offered the same point about selecting a hyperopic patient for earlier cases with presbyopia-correcting IOLs. “That’s a person you’ll make happy no matter what you do,” Dr. Williamson said. His other advice is to understand that different optics and different materials perform differently, and the patient education and informed consent need to be tailored as such. “The most important thing you can do as a young surgeon is master the preop consult and preop expectation setting,” Dr. Williamson said. He also said to tell patients they will experience glare and halos with these lenses; make it very clear what the side effects will be and that they might experience them for a few months. “… pick the right patient and let them know ahead of time what the shortcomings of the lens may be; if you do that, you’re going to save yourself from 99 % of pitfalls postoperatively,” Dr. Williamson said. With more and more presbyopia-correcting IOLs coming to the market, will they increase the marŽet share¶ Dr. Williamson thinks so to some extent, but he doesn’t think these technologies will earn a significant portion of the marŽet oÛerall. 7hy¶ irst is costÆ r. Williamson said some patients can’t afford premium lenses or don’t want to pay out of pocket for their IOLs. The second reason is meeting expectations; some physicians, he said, are not comfortable with setting these expectations and/or needing to meet them for patients who are choosing to pay out of pocket. “As the lenses get better and as we get better at selecting the right patients and the right diagnostics, I think you’ll see adoption go up,” he said, adding that younger generations of ophthalmologists coming into practice could be a force to increase adoption of presbyopia-correcting IOLs. EWAP Editors’ note: Dr. Donnenfeld practices at Ophthalmic Consultants of Long Island, Garden City, New York, and has interests with Alcon, LensGen, and Johnson & Johnson Vision. Dr. Williamson practices at Williamson Eye Center, Baton Rouge, Louisiana, and has interests with Johnson & Johnson Vision. Dr. Yeu practices at Virginia Eye Consultants, Virginia Beach, Virginia, and has interests with Alcon and Johnson & Johnson Vision. Sheetal Brar, MD Senior Consultant & Research Director, Nethradhama Superspeciality Eye Hospital 256/14, Kanakapura Main Road, Jayanagar 7th Block, Bangalore, Karnataka, India brar_sheetal@yahoo.co.in ASIA-PACIFIC PERSPECTIVES T hese are exciting times for us as modern cataract surgeons as we are privileged to have an array of options available in multifocal IOL technology to offer to our patients. Even though spectacle independence with modern trifocals is excellent, occasionally, for some patients, especially those who drive at night] glare and halos may Le significant. Ƃlso] patients who read for long hours may not be very happy due to the reduction in their contrast sensitivity. In this context, I particularly resonate with Dr. Yue’s idea of coupling an extended depth of focus (EDOF; Vivity, Alcon) and a trifocal IOL (PanOptix, Alcon). I have also observed excellent outcomes while performing a similar kind of mix and match using AT LARA EDOF (Carl Zeiss Meditec) in the dominant eye and a trifocal IOL (AT LISA TRI, Carl Zeiss Meditec) in the nondominant eye of the same patient. /his strategy helps to mitigate the dysphotopsia profile of the trifocal while providing excellent near vision. Combination multifocal-EDOF IOLs, such as Synergy (Johnson & Johnson Vision), is another novel concept that combines multifocal diffractive and extended depth of focus technology. According to the experts 1 and my initial personal experience, patients with this implant are able to read properly even in low-light conditions, without the need for additional light. As Dr. Williamson explained, the lens blocks violet light, which is a shorter wavelength, causing more light scattering. This unique feature enables the lens to perform well in low-light conditions as well. We at Nethradhama are excited to start a comparative study, which aims to compare the functional vision and optical quality between PanOptix and Synergy IOLs, shortly. Finally, as Dr. Donnenfeld said, with the introduction of Juvene (LensGen), the wait for an ideal accommodative lens seems to be over. With a wide defocus of about 2.5 D, the lens is supposed to provide similar quality of vision as a monofocal lens without dysphotopsias or reduction in contrast. ore data is awaited to confirm these initial claims. In addition to the great advice given to young ophthalmologists by all the experts, I would like to add that it is equally important to do your homework right. A detailed preoperative examination and appropriate counseling still form the most important component of premium IOL practice. These help us to choose the right patient, who is more likely to be happy after presbyopia-correcting IOL surgery. References 1. Patient Consultation to Postsurgical Success. Supplement to Cataract and Refractive Surgery Today (CRST) , July/August 2021. Editors’ note: Dr. Brar is a consultant for Carl Zeiss Meditec.