CATARACT EWAP JUNE 2023 25 said residual refractive error can contribute to complaints like night glare and blur. She said a careful manifest refraction is mandatory. “If uncorrected refractive error is the cause, giving the patient an accurate refraction should correct the visual complaints,” Dr. Tsai said, but the bigger concerns are usually things like irregular corneal astigmatism or higher order aberrations. Dr. Wang shared similar thoughts. “Residual refractive error, especially residual astigmatism, may cause the postop dissatisfaction,” Dr. Wang said. “Performance of meticulous manifest refraction may determine if the postop dissatisfaction is caused by residual refraction error.” EWAP References 1. Choi A, et al. Accuracy of total corneal power calculation for multifocal toric intraocular lens implantation: swept-source OCT-based biometer vs Scheimpflug tomographer. J Refract Surg. 2021;37:686–692. 2. Chung HS, et al. Comparing prediction accuracy between total keratometry and conventional keratometry in cataract surgery with refractive multifocal intraocular lens implantation. Sci Rep. 2021;11:19234. Editors’ note: Dr. Riaz is Clinical Associate Professor, Dean McGee Eye Institute, Oklahoma City, Oklahoma. Dr. Tsai is Professor of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri. Neither declared any relevant financial interests. Dr. Wang is Professor of Ophthalmology, Baylor College of Medicine, Houston, Texas, and has interests with AcuFocus, Alcon, and Carl Zeiss Meditec. Many surgeons are waiting for the one and only Formula X to come out. Since the first IOL formula was developed, many researchers have developed better formulas, and we have used them in practice. The choice of the formula depends on the surgeon’s preference and experience, as well as the characteristics of the patient’s eye. When a new formula is reported to be superior at an academic conference, we should not stick to our existing formulas but rather actively try to use the new formula. In presbyopia-correcting IOLs, accurate power calculation is desirable. In this article, all surgeons use multiple formulas or online formulas provided by ASCRS and ESCRS. Even in an era when optimal IOL power can be obtained not only from preoperative measurements but also from intraoperative measurements, we are aware that small differences in the postoperative fixation of the IOL can cause refractive errors. From this point of view, there are limitations in determining IOL power using the formulas, and the future development of an IOL that allows adjustment of the IOL power after insertion is expected. For advanced technology IOLs such as presbyopia-correcting IOLs, patients need to become familiar with how they see through these IOLs. The time required for neuro adaptation is discussed in terms of months to a year. When patients no longer complain about their vision, ophthalmologists should understand whether this is due to neuroadaptation or as a result of patients giving up on their vision problems. In both cases, we believe it is important to provide a realistic preoperative explanation so that the actual postoperative visual acuity is as good as the expected vision. Binocular vision is important in the process of getting used to presbyopia-correcting IOLs. However, after surgery, many patients tend to compare their vision in the right eye with that of the left eye. Although the vision of both eyes is never exactly the same before surgery, patients tend to ignore this and fixate on how they see after surgery. It may be wise to explain this discrepancy before the surgery, too. With the introduction of presbyopia-correcting IOLs, we are reminded of the importance of preoperative IOL power calculation, explanation of postoperative vision, and binocular vision. We should continue to share new knowledge and exchange opinions in order to achieve better clinical outcomes of presbyopia-correcting IOLs. Editors’ note: Dr. Bissen-Miyajima is a consultant for Alcon, Johnson & Johnson, and HOYA. Hiroko Bissen-Miyajima, MD Professor, Department of Ophthalmology Tokyo Dental College Suidobashi Hospital 2-9-18 Kanda-Misakicho, Chiyoda-ku, Tokyo, Japan 101-0061 bissen@tdc.ac.jp ASIA-PACIFIC PERSPECTIVES Potential issues - from page 22 complaining that their eye is uncomfortable, irritated, or doesn’t feel right, Dr. Tipperman will do a normal staircase approach to dry eye. People don’t realize that cataract surgery is surgery, he said, adding that it’s important to stress to patients that they’re still going through a healing phase following the procedure. “I think the most important thing is to maintain a good therapeutic relationship with the patient so that they know that you think their problems are important,” he said. “If they know that you’re going to stick with them and do everything you can to make them comfortable, it gives you a lot of mileage and time for most of this to get better.” In terms of new technologies to help with some of these issues, Dr. Tipperman said the biggest improvement has been to IOL power formulas. It’s impressive how much better the newer formulas are than some of the older ones, he said, adding that this is an important message because some physicians are still using the older formulas in their practices. EWAP Editors’ note: Dr. Miller is Kolokotrones Chair in Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California. Dr. Tipperman is attending surgeon at Wills Eye Hospital, Philadelphia, Pennsylvania. Neither declared any relevant financial interests.
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