EyeWorld India June 2013 Issue

June 2013 9 EWAP FEAturE Now, then When asked how, if at all, their use of premium IOLs has changed since they began using them in the early 2000s, a group of physicians had varied responses. Dr. Lane said his use of presbyopia-correcting lenses has changed—he is more confident now. “You have to gain a certain amount of experience using them and [knowing] how to deal with patients expectations and how to choose patients,” he said. “I think that I’m better at selecting patients that will do better with presbyopia- correcting lenses than I was when I first started using them 10 years ago or so. I have better discussions with patients as to the pros and cons in terms of their particular needs and a better handle on the types of issues they may encounter after implantation. Finally, I think that the presbyopia-correcting lenses, particularly the multifocal lenses that are available now, are better than the original multifocal refractive and diffractive lens that were available when we first started using them.” Douglas D. Koch, MD , professor and the Allen, Mosbacher, and Law Chair in ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA, said he has been cautious with presbyopia-correcting premium IOLs and has only modestly increased his use of them through the years. “My level of use is relatively low and has grown only minimally,” he said. “I have a greater level of confidence now with patients not being terribly bothered by glare and halos with either of the two lenses, the ReSTOR or the Tecnis, but I have a great appreciation for how finicky the issues are, with regard primarily to astigmatism, but also the accuracy of the spherical correction.” If the refractive outcome is Views from Asia-Pacific Haike GUO, MD, PhD Guangdong Provincial People’s Hospital Zhongshan 2 Road, Guangzhou, China Tel. no. +86-020-83844380 Fax no. +86-020-83844380 guohaike@medmail.com.cn T he emergence and development of premium IOLs is an inevitable phenomenon because people are pursuing a better life and higher visual quality. Meanwhile, the advanced operation techniques, the enhanced accuracy of IOL measurement and better material and manufacture of IOLs made this dream possible. The Array multifocal IOL which came out in 1997 seems to be able to satisfy people who ask for both far and near good visual quality and the toric IOL made in 1994 brought hope for patients who needed astigmatism corrected by surgery. Many other premium IOLs have since come into the world, which claim to be able to satisfy more patients since their function seemed more perfect. However, some people implanted with these IOLs still complained. The reasons for their dissatisfaction are complicated. On one hand, the premium IOL really brings in some new problems such as the dazzling or decreased contrast sensitivity caused by multifocal IOLs. On the other hand, people are expecting too much from these premium IOLs. Although ophthalmologists and companies are making every effort to solve these problems, it seems that one of the best ways to reduce dissatisfaction is to select patients more carefully, give them more education and more notice about these IOLs. “To Cure Sometimes, To Relieve Often, To Comfort Always,” said E. L. Trudeau. Nowadays, even though the medical technology has improved quite a lot, no doctor can deny the fact that there are still many problems that can’t be solved. Giving patients personalized treatment programs, noticing the psychology of patients and giving adequate education reflect the spirit of human caring which is a great step in the right direction. This is especially important in patients who ask for premium IOLs because some of these patients are perfectionists. Meanwhile, it needs to be emphasized that there are still a lot that can be done to improve the application of premium IOLs: finding new materials for IOLs, looking for better manufacturing processes, designing a more precise IOL calculating formula or developing new surgery and different IOL implantation modes. Besides, the use of femtosecond lasers in cataract surgery can improve the accuracy during surgery, which might be a good decision. We must believe that the premium IOLs is a trend that is becoming better, so it will be more widely used in the future. Editors’ note: Prof. Guo is a consultant for Alcon, but has no financial interests related to his comments. Mahipal SACHDEV, MD Chairman & Director, Centre for Sight Group of Eye Hospitals B-5/24, Safdarjung Enclave, New Delhi 11029, India Tel. no. +91-9810046017 drmahipal@gmail.com I nteresting to read the article by Erin Boyle on premium IOLs. Personally, my experience with premium IOLs over the past 15 years has made me wiser but definitely more keen to use them in my patients. In Asia, the last decade has given us a major turnaround in global economics with more patients in our practice wanting the best that money can afford and being highly demanding as well. Armed with all the information that the internet can provide, patients often reach us well informed not only about the advantages but even the complications. I find my usage of premium IOLs has not remained the same or grown minimally like Dr. Douglas Koch but has gone up significantly in the last decade or so. With the advent of the femtosecond laser for cataract surgery combined with IOLMaster (Carl Zeiss Meditec, Jena, Germany) for accurate IOL power measurement and OCT for posterior segment evaluation, we find we are better able to plan our approach to patients and give them superior results. Tackling of co-existing astigmatism with the arcuate incisions of femto-laser cataract systems is a definite advantage and the optimum capsulorhexis size and location makes us more confident in providing optimum results. I use the whole gamut of lenses from toric and multifocal to accommodating and toric multifocal and find a majority of my patients fairly happy and satisfied. Patient counseling remains an important factor as the other authors have mentioned and understanding patient needs is crucial to deciding which IOL would be most appropriate for a particular situation. Overall, I feel, as technology continues to advance both in terms of surgery and IOLs, assuredly the usage of premium IOLs will further increase simply because our patients desire near perfect vision without the aid of glasses and we will have to strive to provide them the same and more. Editors’ note: Dr. Sachdev is a consultant for Alcon, Allergan, Abbott Medical Optics, Bausch+Lomb, and Zeiss, but has no financial interests related to his comments. continued on page 12