since glare from oncoming traffic is perceived to be worse out of that eye.” In general, she said surgeons should have two main considerations: attaining a prediction error within target, and patient satisfaction levels. Only then should they move forward with the contralateral eye. If positive dysphotopsia presents, she suggested considering enhanced monofocal or refractive EDOF in the second eye. The Light Adjustable lens features photosensitive macromers that change shape with UV light that can be adjusted up to 2 D from baseline and can also correct up to 2-3 D of astigmatism. “It’s used in standard cataract surgery,” Sam GARG, MD said. “Because the lens was designed to be adjusted postoperatively, it eliminates some of the potential postoperative complications that necessitate more chair time from surgeons,” he said. The APACRS Perspective Prof. Barrett said the first time monovision was mentioned dates back to India in the 6th century, and the concept has not changed, although how it’s addressed surgically has. All surgeons must ask themselves, “What optical principle will provide patients with a solution to their visual issues?” “In order to answer that question, you must understand the optical properties of the lens you choose,” Prof. Barrett said. 1988 marked the introduction of multifocal IOLs. “The issue is that it took a single focal point and split it into different foci, all of which sacrificed focal quality,” he said, noting that all diffractive multifocal IOLs produce substantially more halos than their monofocal counterparts. As such, he believes enhanced monovision can be a viable alternative for presbyopia. Each EDOF lens has its own characteristics, including different defocus curves. “What’s the optimum resolution? Right now, it is the balance between perfect resolution and adequate depth of focus,” Prof. Barrett said, and encouraged attendees to disregard spectacle independence as the primary goal for patient satisfaction and concentrate more on contrast sensitivity. “There is an opportunity for blended vision. You want to maintain binocular vision and reduce stereoacuity,” he said. “It’s worth considering enhanced monovision as a solution for your patients with presbyopia.” Sri Ganesh, MD listed several common pitfalls with today’s current IOLs, among them photic phenomena, rotational stability of toric IOLs, and the inability to use advanced technology lenses after complications. With fixated IOL designs, surgeons need to produce perfect 4.8 mm rhexis, and a posterior capsulotomy is required. A novel concept, the swivel haptic IOL, came to him while he was riding his motorcycle and put the kickstand down. “This lens is a single-piece, open loop, hydrophobic, acrylic toric IOL,” he said. The 6mm aspheric optic is 13 mm overall, with two extra swivel haptics 2.5 mm long (comprised of proprietary material). These haptics swivel over a pivot, and the A constant is 117.1 “because the lens sits more anteriorly,” he said. The thickness offsets a higher risk of dysphotopsia, he added. The first-in-human studies evaluated a sample size of eight eyes (six patients); initial inclusion criteria included cortical cataract or nuclear sclerosis with at least 1.5 D
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