EyeWorld Asia-Pacific December 2021 Issue

FEATURE EWAP DECEMBER 2021 7 is staLle. º/hen we can treat what they have as a leftover prescription after cataract surgery,” he said. For patients looking for both distance and near vision, Dr. Solomon said there are multiple options. º n my armamentarium] I go to a trifocal, like PanOptix [Alcon], or extended range of vision lens, like Vivity [Alcon],” he said. The choice in this scenario is also influenced by the patient’s desires and lifestyle. º f the priority is to have the best quality of vision at night and the patient might be more dependent on readers, I might go with Vivity,” he said. º onoÛision is another popular option, especially for those patients who have enjoyed monovision with previous refractive surgery or contact lenses. Monofocals, torics, extended range of vision lenses, and the Light Adjustable Lens are all great options to pursue monovision. The Light Adjustable Lens is particularly intriguing in that patients can test drive monovision and have it removed if they don’t like it. They can also have their monoÛision fine‡tuned to their specific needs.» 7hile r. -olomon said he does get some patients who come in wanting one type of technology, he said they often change their mind once they talk it through with him. º want to better understand their lifestyle, their visual needs, and what they’re looking for,” he said. º ecause at the end of the day] our job is to provide the vision that people are looking for so they can lead the lifestyle they desire.” Dr. Solomon said he doesn’t use any simulation programs to help with this process, but he does use VERACITY Surgical software (Carl Zeiss Meditec). º f a patient is looŽing for a certain visual outcome, we have to make sure we deliver on that]» he said. 7ith eÝtended range of vision lenses, trifocal lenses, and other options, the preoperative measurements are very important. VERACITY, he said, interfaces with the electronic health record and diagnostic equipment and assimilates all the information together, such as any ocular pathology that may affect an IOL choice, as well as surgically induced astigmatism and posterior corneal astigmatism. º f the patient wants good distance and near vision and to be less dependent on glasses, I know I can accurately achieve that outcome with this software,” Dr. Solomon said. º6 ,Ƃ /9 doesn½t maŽe decisions for me. Rather it assimilates all of the information from the electronic health record and diagnostic devices and provides solutions based on my preferences. It also optimizes surgeon factors and tracks outcomes automatically.” ‘There are pluses and minuses to each lens’ Naveen Rao, MD, splits patient education and IOL selection into two Ûisits. or the first visit, he has the technician do a refraction, dilate the eyes, and perform a macular OCT. Then Dr. Rao sees the patient, looks at the testing, and determines if he would consider that patient a candidate for a premium IOL or not. Dr. Rao explains cataract surgery in general in this first visit and tells patients that they will discuss specific lens options during the second visit. He tells the patients to think about the goals for their vision. For example, options include having vision set for distance and wearing glasses for reading, setting vision for near and wearing glasses for distance, or trying to achieve good vision without glasses for all ranges. Dr. Rao said he makes sure to note to patients that some lenses may be covered by insurance while others are not, and there may Le out‡of‡pocŽet costs. Some patients jump in at this point to say they don’t want any options that are not covered by insurance, in which case he knows not to talk about that technology. uring this first Ûisit with the patient, Dr. Rao will share the OCT scan to explain why they may not be a candidate for certain lenses. On the second visit, Dr. Rao said he will have a biometry and topography done but doesn’t do too much additional testing at that Ûisit. º want to dedicate that time to having a discussion with them,” he said. He will spend time reviewing the scans and showing them the topography. He’ll also discuss astigmatism, if the patient has it. For those interested in multifocal lenses, Dr. Rao specifically discusses the potential for dys‡photopsias] telling patients that they will likely see glare and halos around streetlights and stoplights. º any patients get used to it and will become less bothered over time, but there are some patients who are very bothered by those distortions, so I want them to understand that if it’s not something they’re willing to accept, it might not be the best choice.” Dr. Rao said he has a number of patients who come in very