EyeWorld India June 2013 Issue

12 June 2013 EWAP FEATURE correct, patients are “extremely happy,” he said, but that can be difficult to obtain. “I warn patients of that in advance and if they seem like they are not going to be tolerant of a ‘process’ in treating their presbyopia, rather than an immediate result, I tend to back away,” Dr. Koch said. “Conversely, I am doing much more monovision than before, aided by the outstanding results we see with toric IOLs.” According to Dr. Pepose, he uses the lenses with the same approach as when he began using them in approximately 2004. He now uses multifocal, accommodating, and toric lenses in “varying degrees”. “There’s no one size fits all,” he said. “I try to find out from patients what’s the most important thing for them—in other words, are they going to be disappointed if they need reading glasses, are they going to be disappointed if the computer distance isn’t good? What is it that they want to maximize?” After Dr. Pepose determines what patients are seeking in a premium IOL, he obtains clinical information about their ocular status, angle kappa, higher-order corneal aberrations, and pupil dynamics. With that information, he selects the most appropriate lens for that patient. “I try to select the lens based on the patient, and it’s something I’ve always done. Maybe I’ve gotten better at it as time goes on,” he said. Patient education Determining what patients are seeking in a premium IOL can be difficult but vital to successful outcomes. At Wallace Eye Associates, Alexandria, La., USA, practice surgeon R. Bruce Wallace III, MD , clinical professor of ophthalmology, Louisiana State University Medical School and Tulane Medical School, New Orleans, introduced a specific visit to address patient needs several years ago. “It’s a little extra time for the patient, but we found it well worth it when it comes to seeing happy patients postoperatively,” said Dr. Wallace. Robert T. Crotty, OD , clinical director, Wallace Eye Associates, explained the additional visit, called a “premium IOL assessment.” When patients come into the office for their initial exam, they are given a packet of material about presbyopia- correcting IOLs and scheduled for a follow-up visit to address their potential for a premium IOL. At that visit, they view a video on the lenses and undergo tests. “We’ll do a dry eye assessment on the patient, we’ll do the WaveScan [WaveFront System, AMO], the topography, the OCT to rule out any pathology. We check for high dominancy, we’ll do pupil size. We’ll ask them questions about their lifestyle, if they’re on the computer and how many hours a day. We’ll want to know if they drive a lot. We’ll want to know their past experience with contact lenses. Have they ever tried monovision? We want to know what kind of glasses they wear. Then we ask them what they think their personality is. Do they feel like they’re very easy-going, or do they feel that they’re a perfectionist?” he said. For those patients with excellent clinical parameters but who identify as perfectionists, care is taken to instruct them about how the lenses are not perfect, Dr. Crotty said. “The real key to all this is patient education, that extra time you spend with the patients, getting them to understand what the process is,” he said. Some patients have returned for the second visit, which lasts approximately 30 minutes, gone through the testing and questionnaires, and at the end of the process, both physician and patient realize that they are not good candidates. Those patients are then given other options, such as a monofocal lens. “The worst thing that can happen is [an] unhappy patient,” Dr. Crotty said. “I don’t think any surgeon is happy about going in and explanting a lens. This is a risk factor that’s there.” Dr. Wallace agreed. He said that patients are already well educated about lenses from the internet and word-of-mouth. If they are not provided the possibility of a premium IOL, they could learn about the lenses in other ways and be unhappy because they were not given a chance to have one implanted. “I think patients have a better knowledge now,” said Dr. Wallace. “They understand what’s going on. We are much more careful about things such as dry eye and assessing that preoperatively, treating it aggressively postoperatively.” EWAP Editors’ note: Dr. Koch has financial interests with Alcon, AMO, OptiMedica (Sunnyvale, Calif., USA), and Ziemer (Port, Switzerland). Dr. Pepose has financial interests with AMO, Bausch + Lomb, Calhoun Vision (Pasadena, Calif., USA), and ELENZA (Roanoke, Va., USA). Dr. Wallace has financial interests with AMO, Allergan (Irvine, Calif., USA), and Bausch + Lomb. Dr. Lane has financial interests with Alcon, AMO, Bausch + Lomb, and PowerVision (Belmont, Calif., USA). Dr. Crotty has no financial interests related to this article. Contact information Crotty : 318-448-4488 Koch : 713-798-6443, dkoch@bcm.edu Lane : sslane@associatedeyecare.com Pepose : 636-728-0111, jpepose@peposevision.com Wallace : rbw123@aol.com A decade - from page 9 Index to Advertisers AMO – TECHNIS Family of IOLs Page: 26 , 27 www.AbottMedicalOptics.com Carl Zeiss Meditec AG Page: 39 www.meditec.zeiss.com/ReLEx Moria Page: 45, 53 Phone: +33 (0) 146744674 Email: moria@moria-int.com www.moria-surgical.com Oculus Optikgerate GmbH Page: 49 Phone: +852-2987-1050 Fax: +852-2987-1090 Email: info@oculus.hk www.oculus.de Synergetics Inc Page: 2 Phone: +636.939.5100 Fax: +636.939.6885 Email: customerservice@synergetic- susa.com www.synergeticsusa.com Technolas Perfect Vision GmbH- A Bausch + Lomb Company Page: 19 Phone: +65-6592-0792 www.technolas.com – www.bausch.com Topcon Singapore Medical Pte Ltd Page: 55 Phone: +65-68720606 Email: medical_sales@topcon.com. sg www.topcon.com.sg World Ophthalmology Congress (WOC 2014) Page: 35 www.woc2014.org Ziemer Ophthalmic Systems Page: 64 www.ziemergroup.com ASCRS Page 13, 20 , 40 www.ascrs.org APACRS Pag e 5, 7, 10, 11, 47 , 51 , 63 www.apacrs.org www.2013apacrs.org