EyeWorld India March 2012 Issue

March 2012 27 EW FEATURE candidates,” said Chet Kumar, PhD, vice president, Business and Market Development, VisionCare. “If they pass that, patients will see the low-vision occupational therapist who will figure out what their functional goals are and if the technology’s capabilities are in line with that. [The OT] will relate back to the ophthalmologist if the patients have good rehab potential.” It helps if patients are upbeat, hard workers with reasonable expectations. Patients should be active with their low vision as well, not people who are having their daughter or son do all the reading for them. “People who come in with a glass half full attitude will probably do better,” said Henry Hudson, MD, Tucson, Ariz., USA. “Women do a little better than men. People who are artists do better than people who are not artistic. I think the best candidates are people who have realistic expectations. They have hopes, but realistic expectations, and they are motivated to do the work. It’s very much a program. It’s not a procedure. If they accept that it’s a program and there’s a rehab component, they tend to do much better.” How long it takes a person to adjust to the telescope is individually based. There’s no real way of assessing that upfront, but the simulator gives patients and physicians some idea. “The goal is for patients to know what they’re getting,” said Dr. Hudson. “Most of our simulators underestimate the success. If patients are happy with how they do in testing, they should be happier with the actual result.” Most patients are extremely happy and grateful for the device and their functional improvements. According to Dr. Hudson, the average patient goes from being legally blind to reading a Kindle with glasses. “All in all, people I talk to say they’re glad they did it, even though it’s not a cure. It’s an option,” said Dr. Kumar. “It’s for the people who want to be able to Monthly Pulse Keeping a Pulse on Ophthalmology T he Monthly Pulse Survey for December clearly underscores the interest ophthalmic surgeons have in new technology. Not surprisingly, cost is the overriding concern for introducing femto cataract surgery into our practices. IOLs continue to evolve, and premium lenses that are only available outside of the U.S. are a continuing source of frustration for American surgeons and our patients alike. In our survey, limbal relaxing incisions are used by only 11% of surgeons, demonstrating the overwhelming acceptance of toric IOLs for patients with astigmatism. The jury is still out on corneal inlays for presbyopia, but we look forward to learning more about this option as the international experience continues to accumulate. -John A. Vukich, MD, international editor T he Monthly Pulse Survey has covered some very interesting topics, and there are a lot of take-home messages from it. When we look at femto cataract surgery, the reality is the cost. The issue is not only of buying costly equipment but also of the cost per case that will hit the doctor and the patient. This comes out very clearly in the survey. Another issue is whether the technology has gotten to a level where it can replace phaco. The answer to that is obviously no. As far as IOL technology, every ophthalmologist would like to have the latest and most useful IOLs in their armamentarium. In India we have access to all these IOLs like the toric phakic and multifocal IOLs, and they are a real boon to the patients. Coming to the third question on toric IOLs, once again, they have definitely made a huge impact on our results. They are also easier to implant, and it is very clear in the survey that doctors want this technology. In the final question of corneal inlays, the response is clear that one needs more time with corneal inlays to make a final call. All in all, this survey tells us the direction high-tech ophthalmology is moving in and helps us all keep pace with it. -Amar Agarwal, MS, FRCS, FRCOphth, international editorial board member T he femto cataract surgery hype is creating a lot of buzz at international congresses. But the big question is, who is going to pay for all this exciting technology? The future will tell us how successful this new technology will be. The second question concerning IOLs not available in the U.S. raises some interesting thoughts. All of these lenses have terrific indications and have proved their efficacy and safety for patients and broaden the range for surgeons to correct higher degrees of astigmatism. Toric IOLs, if properly positioned in the eye, correct astigmatism effectively and are not subject to loss of correction over time, like LRIs. Last but not least is presbyopia correction, the holy grail of ophthalmology. We can partially get rid of reading glasses with corneal inlays, but we need to provide patients with adequate expectations about this technology. The big advantage is its reversibility. It’s obvious that many surgeons are still not familiar enough with this technology. -Erik L. Mertens, MD continued on page 44