EyeWorld Asia-Pacific March 2021 Issue

FEATURE EWAP MAR C H 2021 9 Sandeep Nagvekar, MD Medical Director, Nagvekar Eye Clinic 102 Push Panjali, S.V. Road, Santacruz, Mumbai 400054, India s_nagvekar@hotmail.com ASIA-PACIFIC PERSPECTIVES I t was with great interest that I read the article by Dr. Hercules Logothetis highlighting the various preferences elicited from surgeons in a survey regarding their choice of IOL and technology during their own cataract surgery. Being a physician engaged in private practice in Mumbai for the past 34 years and fast approaching an age wherein development of cataract is quite common, similar thoughts have crossed my mind too regarding my choice were I to get operated. In the article, Dr. Logothetis concludes that most surgeons based their personal surgical decision on their familiarity with a particular IOL or technology. It should be noted here that in this survey, only two-thirds of surgeons were implanting MF IOLs and only 44% were trained to perform FLACS. So as expected, responses were found to be greatly varied across the board. While most of these observations would resonate well with most of us, the ground realities are a bit different. Femtosecond laser technology has not yet had quite the same penetration in this part of the world and some of the IOLs such as the Light Adjustable IOLs, truly accommodative IOLs, and non-diffractive presbyopia-correcting IOLs are either not available or are still in their infancy. Surgeon lifestyles too vary greatly depending on their region and individual personalities. While postop quality of vision has always played a pivotal role in influencing their selection of a monofocal IOL, with the appearance of newer ERV IOLs in the market that do not split light thereby ensuring better quality of vision than MF IOLs and without causing too many visual disturbances or photic phenomena, surgeon preferences have changed and will continue to evolve with time. I have used multifocal IOLs starting with the 3M Diffractive towards the end of the last century to the present trifocals and have recently started implanting the newer ERV IOLs. I have implanted many multifocal lenses in some of our colleagues from other surgical specialties including laparoscopic surgeons, urologists, and gynecologists with extremely rewarding results. Interestingly, only 1 of the 6 ophthalmic surgeons I have implanted bilaterally has opted for a MF IOL. I have been performing FLACS for the past 6 years and using digital image-guided systems for my refractive cataract procedures. Personally speaking, I am a hyperope with 0.75-D ATR astigmatism in my non-dominant left eye who has used progressive glasses for nearly two decades. While glasses independence would certainly be on my wishlist, if I were to continue operating, I think I would choose either an aspheric monofocal or the newer Vivity IOL from Alcon with some mini-monovision in my non-dominant eye. I am sure a lot of colleagues who are passionate about outdoor activities such as driving, golf, and tennis would agree with this. I would opt for a FLACS procedure and have the toric model implanted in the left eye. On the other hand, post-retirement I would opt for the Panoptix as my closest option to achieving spectacle independence. Editors’ note: Dr. Nagvekar declared no relevant financial interests. his coauthors weren’t surprised by the findings. “The overall lesson was that surgeons based their personal surgical decisions off of familiarity. The more they worked with different technology (femto or multifocal), the more likely they are to use it,” he said. When asked what IOL he would select, if he currently needed cataract surgery, Dr. Logothetis presented his case: As a 33-year-old post- LASIK patient who worked with the Light Adjustable Lens (LAL, RxSight) during fellowship, Dr. Logothetis said he was pleased, based on that experience, with what it offers post-LASIK patients. “Today,” he said, “I’d do a LAL for distance, but I don’t really know because I’ve never tried monovision. If PanOptix [Alcon] results with post-LASIK patients are good, I’d strongly consider that.” EWAP Reference 1. Logothetis HD, Feder RS. Which intraocular lens would ophthalmologists choose for themselves? Eye. 2019;33:1635–1641. Editors’ note: Dr. Logothetis is in practice with Eye Physicians of Libertyville, Libertyville, Illinois, and declared no relevant financial interests.