EyeWorld India December 2014 Issue

60 EWAP NEWS & OPINION December 2014 Finally Suhas Haldipurkar, MD, Panvel, India, discussed why he does not yet have a femtosecond laser system. He said when deciding to invest in this type of technology, a number of questions need to be answered. These are: Am I convinced of the technology? Will it make a significant difference? Will the cost benefit ratio tilt in favor of the patient? He concluded that he does not currently see any benefit in this type of machine. Day 3: Saturday, 15 November 2014 The latest advancements in IOL technology With IOL technology evolving rapidly, ophthalmologists can now offer spectacle independence at a wider range of distances than ever before. Saturday morning’s session “IOLs: The Jewel in the Crown” highlighted the latest advances in premium IOL technology and design, focusing on IOLs that provide additional focal points and those that reduce unwanted visual effects. When it comes to offering a full range of vision, accommodating lenses are the solution, but these lenses aren’t available yet, said Eric Donnenfeld, MD , Rockville Centre, NY, U.S. “Accommodating lenses are the answer, but they just don’t exist,” Dr. Donnenfeld said. “If we had an accommodating lens, we wouldn’t be having this conversation today.” Without accommodating lenses, there are still several options for patients wanting spectacle independence. Dr. Donnenfeld described one such lens, the TECNIS Symfony extended depth- of-focus (EDF) IOL (AMO). Instead of creating multiple images on the retina as multifocal and trifocal lenses do, EDF lenses have an extended focal point, creating just one retinal image that significantly reduces the occurrence of dysphotopsia. A loss of contrast sensitivity accompanies the extended range of vision, but this is partly restored by proprietary technology that corrects chromatic aberration, Dr. Donnenfeld said. TECNIS Symfony IOL patients have so far experienced high levels of spectacle independence at far, intermediate, and near distances, Dr. Donnenfeld said, and patient satisfaction has been incredibly high—97% of patients said that they would elect to have the lens implanted again. Dr. Gatinel, Paris, France, described the FineVision diffractive trifocal IOL (PhysIOL, Liege, Belgium), which combines two apodized diffraction patterns—one for distance and near and one for distance and intermediate—to provide patients with distance, intermediate, and near vision. Intermediate vision became a daily need in the computer age, Dr. Gatinel said, and its need grew further with the introduction of tablets and smartphones. Coincidentally, the FineVision IOL came to the market in 2010, the same year that Apple debuted the iPad, he said. The FineVision lens is a hydrophilic acrylic IOL with a blue and UV light filter that is inserted through a 1.8-mm incision. In addition to having three points of focus, the lens offers pupil-dependent focusing—the lens increases the light available for distance vision in mesopic conditions, reducing glare and halos. A toric version will soon be available, Dr. Gatinel said, that will have a diffractive face on the front surface of the lens and a toric face on the back surface. Simonetta Morselli, MD , Bassano del Grappa, Italy, discussed new and evolving lenses for micro- incisional cataract surgery (MICS). One such lens is the INCISE IOL (B+L), a 1-piece posterior chamber IOL made of an enhanced hydrophilic acrylic material. The INCISE lens utilizes advanced optics technology, Dr. Morselli said, that makes it free from spherical aberrations, less sensitive to tilt, and gives it an enhanced depth of field. The INCISE lens is inserted using a dedicated injector optimized for 1.8 mm MICS incisions. IOL performance during implantation and placement was controlled and predictable, Dr. Morselli said, and the IOL demonstrated predictable and stable centration at 1-2 months postop. D. Ramamurthy, MD , Coimbatore, India, shifted the discussion from new technologies to ways that physicians can enhance outcomes with premium IOL patients. “It is not the IOL that is premium, it is the procedure that is premium,” he said. Achieving good outcomes really comes down to the “garbage in, garbage out” principle, Dr. Ramamurthy said— without a reliable assessment of the aberrational profile prior to surgery, there is no way to achieve a good refractive outcome, he said. There are many ways to enhance outcomes, but in the end, patients are more concerned about how much you care, rather than how much you know, Dr. Ramamurthy said. When patients are unhappy with their refractive outcomes, be sure to acknowledge their dissatisfaction and reassure them that they are not alone, he said. Cataract and refractive surgery: Two sides of a coin How would you treat a 54-year- old male Bollywood star who is a slight hyperope with no cataracts and who wants to be spectacle-free? That was the question posed to Dr. Ganesh, Bangalore, India, and Cordelia Chan, MD , Singapore, at the “Two Sides of a Coin: Cataract versus Refractive Surgery Approach” symposium on Friday afternoon. In this session, several hypothetical scenarios were presented to two surgeons who then debated the best treatment option for the patient from either a cataract or refractive point of view. In this case, Dr. Ganesh took the cataract surgeon’s perspective and recommended a refractive lensectomy with either an extended Jewels - from page 59