EyeWorld Asia-Pacific December 2021 Issue

FEATURE 8 EWAP DECEMBER 2021 educated, having done research on the different IOL options and the potential side effects on their own. For many who come in asŽing aLout specific IOLs, Dr. Rao said he has to explain why they might not be the best candidate for certain technologies. Dr. Rao noted that he also sees a significant numLer of patients referred for IOL exchange for dysphotopsias after multifocal lenses, so he is careful to discuss these potential dysphotopsias with his own cataract surgery patients. º want them to make a completely informed decision about whether a multifocal IOL is the right choice for them, so there are no surprises.” He mentioned newer lens options, like Vivity and Eyhance (Johnson & Johnson Vision). For patients who want good distance vision and want to achieve some mid ‡ range spectacle independence, he recommends Vivity because it does not seem to result in significant glare or halos. º ½m excited about these new lenses and think they have a lot of potential for patients to be happy with less risk of glare, halo, and starbursts and more spectacle independence than our monofocal lenses,” he said. Dr. Rao said he has tried using models/simulations and videos in the past to explain options to patients, but it was often time consuming and he didn½t find it particularly helpful. e finds a customized] face‡ to ‡ face discussion with each patient more effectiÛe. 7ith the video program he was using, there were a lot of videos to choose from. He found this hard for the patient as well as the doctor/staff who had to choose which videos to recommend. In addition, with the number of lens options and packages, he doesn’t want the patient to feel liŽe it½s a sales pitch. º tell the patient that my goal is to help them choose the lens that best suits their needs. It doesn’t matter what their friend or family memLer got]» he said. º7hat matters is what they want, and we can tailor their vision to what they want these days. There are pluses and minuses to each lens. I think patients will be happiest if they know what they’re getting into.” EWAP Editors’ note: Dr. Rao practices at Lahey Hospital & Medical Center, Burlington, Massachusetts, and declared no relevant financial interests° r° -olomon practices at Carolina Eyecare Physicians, Mount Pleasant, South Carolina, and has interests with Alcon and Carl Zeiss Meditec. T he IOL market has burgeoned in recent times and any cataract surgeon, let alone patients with cataracts, could be forgiven for being confused by the plethora of IOLs available on the market. Drs. Solomon and Rao both make very good points in the way they counsel their patients on IOL choices and the watchword here is COUNSELING. Time spent with the patient prior to choosing the most appropriate IOL will yield dividends many times over. I usually start with the premise that most patients actually want spectacle freedom (although they may not say so categorically!) and so all my preoperative assessments are targeted at assessing a patient’s suitaLility for a trifocal lens in the first instance. /his essentially means that I need consistent biometry in an eye with a good ocular surface and that I need to rule out optic nerve or macula pathology so that the patient can deriÛe full Lenefit from a trifocal " . *articular attention is paid to astigmatic correction in all cases. If a patient is deemed to have a healthy eye, it means that any IOL whether multifocal or monofocal can be implanted depending on need. If spectacle freedom is indeed desired, a trifocal would be the lens of choice; if intermediate and far vision with little photic phenomena is the priority, then EDOF IOLs would be considered. If there is mild macula or optic nerve pathology, we would need to consider monovision with monofocal or EDOF IOLs as an option. In all cases, using the latest generation of accurate biometry formulas such as the arrett -uite of alculators www.apacrs.org ® will ensure that the most accurate postoperative outcomes are achieved regardless of whether a monofocal] " ] or trifocal lens is used. 7hile the light‡adustaLle " is admiraLle as a technological adÛancement] in Asia, we need to be mindful of the added cost related to any new technology and carefully assess if the potential Lenefits ustify greater expenditure. ditors½ note\ r° 9eoh declared no relevant financial interests° Ronald Yeoh, FRCS, FRCOphth, DO, FAMS Consultant Eye Surgeon & Medical Director, Eye & Retina Surgeons linical Ƃssociate *rofessor uŽe‡ 1- Grad Med School, Singapore National Eye Centre ry@ers.clinic ASIA-PACIFIC PERSPECTIVES