28 EyeWorld Asia-Pacific | March 2025 REFRACTIVE SURGERY The TECNIS Odyssey, she said, is more of a full range of vision lens, and patients have been blown away by its optical quality and enhanced contrast sensitivity. There is a free-form technology on the optic that minimizes the side effects of glare and starbursts, so these patients have minimal complaints of nighttime dysphotopsias, and they get a good range of vision. “The other one I love is the LAL+ for patients because they come out of surgery already possessing some range of vision, then we can build in a little more with adjustments postoperatively, and this is another lens that gives great quality of vision,” she said. Dr. Hamilton said he frequently sees patients who want to get out of their glasses and tell him they want LASIK. “That might work for someone in their 20s–30s, or even into their 40s, but if someone in their 50s comes in, and they’ve never worn glasses before and are having trouble seeing up close, but they want LASIK, I say, ‘LASIK is done on the cornea. The reason you’re having trouble at 50 is not due to the cornea but rather the lens inside, which loses its flexibility and doesn’t focus as well. It will become cloudy in the future as a cataract develops. A cataract is not a disease but part of the aging process. With RLE, we are preventing cataract formation and restoring vision from distance all the way to the cellphone without glasses.’” Dr. Hamilton’s practice website has a section that discusses options for patients at various ages. The under 40 page has information on LASIK, SMILE, and the EVO (STAAR Surgical), while the over 50 page discusses options like RLE, laser cataract surgery, and the LAL but does not include LASIK. Patients in their 40s–50s require individualized care. Some of the most ideal patients for RLE, he said, are the hyperopes because they were used to not wearing glasses and now are dependent on them at least for near vision and often for distance. They are delighted to get back the unaided near and distance vision. “One of the reasons why I am much more enthusiastic about RLE now is because we have amazing lens implants,” Dr. Hamilton said, adding that he is also excited about the TECNIS Odyssey, which he called “incredible in terms of distance, intermediate, near, and minimizing nighttime halos.” For patients in their 40s and early 50s, quality of vision is still quite good because there is not much nuclear sclerosis. Therefore, they are expecting not to lose this quality with RLE. Some of the multifocal lenses have contrast sensitivity issues that may not be acceptable to patients in their 40s and early 50s from a quality of vision standpoint. “I have not found that to be the case with the TECNIS Odyssey,” he said, noting that this lens is only available in a limited market release right now, but he has been using it since April 2024. “It has been transformational to me in terms of RLE.” Dr. Hamilton also likes to use the LAL in patients who have had previous refractive surgery. “The best patients are the ones who have had previous hyperopic LASIK and patients with smaller pupils,” he said. “They get amazing results from the LAL. The patients who don’t get as much range are the ones with big myopic corrections and larger pupils.” The LAL is still a great choice for post-LASIK patients with myopic corrections, but you have to set the expectations, he said. It’s going to be blended vision; the two eyes will be different. The patient will decide how much near vision they want in exchange for distance quality. TECNIS Odyssey IOL implanted during RLE surgery. Source: D. Rex Hamilton, MD Patricia Fortin, MD, from ClearSight, shows custom lens options to a potential RLE patient. Source: Jaire Zaleta, ClearSight
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