EyeWorld Asia-Pacific September 2021 Issue

REFRACTIVE 32 EWAP SEPTEMBER 2021 40s and 50s may be good candidates for a refractive lens exchange. Dr. Trattler added that with improved technology, patients are usually happy with this option. He said a lens like PanOptix (Alcon), Vivity (Alcon), Symfony (Johnson & Johnson Vision), or Eyhance (Johnson & Johnson Vision) could be considered. Alternatively, a monovision or blended vision strategy with monofocal or monofocal toric IOLs can be considered. LASIK can still be an option for patients in their 40s and 50s, he said, while ICLs are usually not the procedure of choice except with a high level of myopia. “I try to create an individualized, custom approach for each patient,” Dr. Trattler said. He noted that many patients associate the word “LASIK” with improvement of vision to the point of not needing glasses. Many patients don’t understand the different tools and technologies in addition to LASIK that are available to accomplish this goal. Laser vision correction wouldn’t necessarily be the right choice for a patient in their 60s. This patient might be a better candidate for a refractive lens exchange or could need cataract surgery. “If they’re not going to be a good fit for a certain technology, it’s OK to tell them that,” he said. When considering the ICL, Dr. Trattler said that a key criteria is that the eye has a certain size anterior chamber depth. If you have an eye that has a shallow anterior chamber, there will not be sufficient space for the . Allison Jarstad, DO, offers LASIK, PRK, and refractive lens exchange to her patients. “When creating a treatment plan, I have a holistic approach and take the patient’s age, the stability of their refraction, and the entire eye into consideration. A laser procedure is usually the better option for younger eyes that are refractively stable,” she said. She prefers laser refractive procedures as long as the corneal topography shows no evidence of keratoconus or FFK. “I like to leave an RSB of Îää ùm to be safe, but am pretty conservative,” she said. “If there’s anything suspicious on topography and if the patient is young (early 20s), I will monitor for 6 months to a year prior to proceeding with laser vision correction. If the patient is older (40s or 50s), I counsel them on the much lower but possible risk of post-refractive ectasia.” Dr. Jarstad prefers PRK over LASIK for patients with glaucoma in order to avoid an IOP elevation when creating the Ƃ- yap. -he opts for *, in patients with ABMD since they often benefit from a superficial keratectomy. For patients outside of the range of laser refractive correction and who want to avoid intraocular surgery, treating a majority of their refractive error can still yield good results. She sometimes offers PRK on top of a fully healed PKP graft in a young person who doesn’t have evidence of a cataract but has postoperative myopia or astigmatism. If there is topographic evidence of mild keratoconus or FFK, Dr. Jarstad recommends a phakic IOL. However, she cautioned that you need to ensure that the patient receiving a phakic IOL has a deep enough anterior chamber, which usually is the case in highly myopic patients. She also mentioned the importance of obtaining a specular microscopy to ensure a healthy endothelial cell count. For iris-claw phakic IOLs you want to make sure the iris tissue is without atrophy or any abnormalities, Dr. Jarstad added. Though she does not implant phakic IOLs, Dr. Jarstad said she has removed them at the time of cataract surgery for many patients. “I think they are a Positioning of ICL for a patient with high myopia. Source: William Trattler, MD