EyeWorld Asia-Pacific September 2021 Issue

patients who undergo surgery, vision will improve, but it will not be perfect vision. Glares that patients might perceive prior to surgery during nighttime driving will be replaced by halos after IOL implantation, but halos are better compensated by one’s brain than a glare. Astigmatic patients, in general, may see starbursts around light sources, and this will change to a distinct halo that one’s brain can more easily adapt to after surgery. Dr. Kretz also counsels patients to use addition- al light sources, such as a smart- phone flashlight, if it is too dark for reading. “Patients need time to become comfortable with their new vision,” he says. The most important questions to ask patients are how much spec- tacle independence they want and how accepting they will be to dysphotopsia. One also needs to consider the primary distanc- es they require in their work and daily life as well as their night light circumstances and hobbies. Near focus patients are usual- ly simple to treat, and Dr. Kretz prefers to use the AT LISA tri IOL patients with glaucoma in these presbyopic cases. In Dr. Kretz’s experience, the easiest patients to work with are presbyopic hyperopes as they are always good candidates for these types of IOLs. In cases of emmetropes, patients will need careful counseling, and myopic patients should be considered for a slight minus target in their near dominant eye. Careful consideration must be taken for certain patients, and Dr. Kretz explains the exclusion criterias for trifocal IOLs. Patients with other diseases that may limit a positive outcome may not be good candidates for trifocal IOLs and should be assessed thoroughly. Patients with high expectations need to discuss their goals with their doctor so as not to be disappointed. Patients who drive an extensive amount during the night, including truck and taxi drivers, may not be the best fit for trifocal IOLs. “You really have to manage expectation and reality,” says Dr. Kretz. When talking to patients, they often have high expectations of presbyopia correction. Many hope for no compromises in distance vision, no loss of contrast sensi- tivity, good intermediate and near vision, and no loss of long-term stability of optical properties and function, and they hope for no glares, halos, and nighttime driv- ing issues. “In Germany, we call this the eierlegende Wollmilchsau - an all-in-one solution suitable for every purpose. But, this is not possible for patients,” says Dr. Kretz. Surgeons need to find a compromise and set the right expectations. When setting expectations, surgeons must consider different patient circumstances. In cataract which not only provides long-term stability but also results in happy patients. In studies comparing the AT LISA tri IOL to the TECNIS Symfony™ and the TECNIS mul- tifocal IOL, AT LISA tri had better visual acuity results and higher contrast values especially in the near visual range. AT LISA tri also showed less glare and halo per- ception than the Symfony™ IOL. With the next generation EDOF IOLs coming into play, AT LARA IOLs offer a perfect balance for patients seeking spectacle inde- pendence for an active lifestyle with less side effects. AT LARA provides a wide range of focus and less visual side effects than multifocal IOLs. In a questionnaire conducted by Dr. Kretz, he found that many patients were indepen- dent of spectacles in the end. If looking at halo and glare assess- ment, one can really see that AT LARA IOL glare and halo values are lower than other IOLs. Combining the trifocal AT LARA and AT LISA tri IOLs is also pos- sible. This is because AT LISA tri corrects for spherical aber- rations of the cornea and gives distinct focal points and AT LARA enhances depth of focus with neutral spherical aberration. Dr. Kretz’s take home message is that the AT LISA tri IOL is his first choice for true binocular near vision and good overall vision. For patients who want a wide range of focus from distance to near vision yet also want to focus on intermediate tasks, mixing AT LARA and AT LISA tri may be a possibility. Finally, the AT LARA IOLs may be a good choice for patients who wish for a low rate of photopic phenomena with stable visual acuity. Managing cataract and refractive surgery in patients with a multitude of factors and expectations does not have to be a difficult task as both the AT LISA tri IOL and the AT LARA IOL provide beneficial outcomes. “ Managing cataract and refractive surgery in patients with a multitude of factors and expectations does not have to be a difficult task as both the AT LISA tri IOL and the AT LARA IOL provide beneficial outcomes. ” Dr. Florian Kretz, MD, FEBO Media placement sponsored by Carl Zeiss Meditec AG Not all products, services or offers are approved or offered in every market and approved labeling and instructions may vary from one country to another. The statements of the authors of this supplement reflect only their personal opinion and experience and do not necessarily reflect the opinion of Carl Zeiss Meditec AG or any institution with whom they are affiliated. Carl Zeiss Meditec AG has not necessarily access to clinical data backing the statements of the authors. The statements made by the authors may not yet been scientifically proven and may have to be proven and/or clarified in further clinical studies. Some information presented in this supplement may only be about the current state of clinical research and may not be part of the official product labeling and approved indications of the product. The authors alone are responsible for the content of this supplement and any potential resulting infringements resulting from, in particular, but not alone, copyright, trademark or other intellectual property right infringements as well as unfair competition claims. Carl Zeiss Meditec AG does not accept any responsibility or liability of its content. in Cataract and Refractive Surgery