EyeWorld India June 2013 Issue

June 2013 8 EWAP FEAturE Patients do not do well with multifocal IOLs if they have highly aberrated corneas, as shown here by the large amount of verti- cal and horizontal coma at a 6-mm zone using Atlas tomography. Source: Jay Pepose, MD A decade later, premium IOLs still viable option Choosing the appropriate candidates for premium IOLs can improve patient satisfaction T he first premium IOLs on the market were approved some 10 years ago, and since then, a great deal has been learned about not only the lenses, but also the psychology behind implanting them, including the best patient selection and education. “The lenses now are basically modifications of what was first introduced,” said Stephen S. Lane, MD , clinical professor of ophthalmology, University of Minnesota, Minneapolis, Minn., USA. “The majority of the original advanced technology (AT) lenses, first introduced 10 years ago, are no longer available in the form that they were. There’s been this evolutionary change that has occurred with incremental improvements over the years.” Lenses The range of IOLs for the treatment of presbyopia includes multifocal, and accommodating lenses, and toric IOLs to correct astigmatism, each addressing specific visual needs. The accommodating lens Crystalens by Erin L. Boyle EyeWorld Senior Staff Writer (Bausch+Lomb, Rochester, NY, USA) received market approval in 2003, the multifocal AcrySof ReSTOR IOL (Alcon, Fort Worth, Texas, USA/ Hünenberg, Switzerland) received approval in 2005, and the AcrySof Toric (Alcon) was approved in 2005. Other lenses that have gone through iterations include the Tecnis multifocal (Abbott Medical Optics, AMO, Santa Ana, Calif., USA) and the STAAR toric IOL (STAAR Surgical, Monrovia, Calif., USA). Through the years, physicians have learned, by trial and error and good clinical studies, how best to implant these lenses. Dr. Lane said a symbiotic working relationship between the medical community and industry has developed AT lenses into the options now available. “I think that we have a better perspective of the problems that can arise, as we have identified over time the areas where patient satisfaction was not achieved. As patient issues have come to light, companies have tried to address these issues with modifications in the lenses. Incrementally, we now have better lenses that are giving patients better results. They’re not totally solved, but we clearly have a better product than 10 years ago,” he said. Jay Pepose, MD , founder and medical director, Pepose Vision Institute, Chesterfield, Mo., USA, and professor of clinical ophthalmology, Washington University School of Medicine, St. Louis, Mo., USA, said that despite advances in the field and the many improvements in existing lenses, there remains no perfect lens for all patients. Managing patients’ expectations, then, is vital to the best outcomes, he said. Also, informing patients about the “process” of gaining desired vision is necessary. “It’s important to tell patients on the front end that we may not hit the target. Even in our best efforts, we may not 100% hit the target. It would be like a baseball player getting up to bat expecting to hit a home run every time. It’s just not going to happen, no matter how skilled we are,” Dr. Pepose said. “Patients need to be aware that there could be additional steps required. They could need a YAG capsulotomy, they could need LASIK or a laser vision enhancement to get to where they want to be. It’s important for people to know that on the front end because otherwise they’re disappointed, they lose confidence in the surgeon, they say, ‘Why didn’t they tell me this before?’ It’s important to set the stage and explain to patients, ‘We’re going to get you where you need to be, but it could take more than one step to get there,’” he said. AT A GLANCE • Since the first premium IOLs were approved a decade ago, physicians have learned how to best select lenses. • Implanting a premium lens is a “process” that is more than simply implanting the lens. • Educating patients is crucial to success. • Patients are knowledgeable, so they should be presented with all options available.