EyeWorld India June 2015 Issue

June 2015 24 EWAP FEATURE ASCRS members weigh in on presbyopia- correcting IOLs for cataract patients by EyeWorld Staff The 2014 ASCRS Clinical Survey data shows surgeons’ preference for presbyopia-correcting options A chieving monovision with IOLs is a tried- and-true method for presbyopia correction. However, according to the respondents to the 2014 ASCRS Clinical Survey, many surgeons now prefer using multifocal or accommodating IOLs in this patient population. “Monovision is very effective for those patients who can adapt to it,” said Steven Dell, MD , Dell Laser Consultants, Austin, Texas. “The acceptance of monovision is directly related to the degree of defocus used in the near eye. Accommodating IOLs provide some near vision on their own, so only a small additional amount of defocus is required to provide good near vision. In my experience, –0.50 to –0.75 D of defocus is very well tolerated and highly effective in this situation. Non-accommodating standard IOLs require more defocus than this, and sometimes a contact lens trial is helpful in this situation. In the context of cataract surgery, this is sometimes impractical. “Ultimately, we need IOLs that achieve good uncorrected distance, intermediate, and near vision,” he said. Survey respondents to the 2014 ASCRS Clinical Survey were asked the percentage of their cataract cases they target for monovision rather than implanting presbyopia- correcting IOLs (Figure 1). On average, U.S. respondents target for monovision rather than implanting presbyopia-correcting IOLs in their cataract cases nearly 50% more than non-U.S. respondents (26.7% versus 18.4%). U.S. surgeons target monovision in less than one-fifth of their patients. The difference in response between U.S. and non-U.S. surgeons is statistically significant. Dr. Dell noted that monovision is sometimes chosen for economic reasons. “Multifocal IOLs require substantial financial participation from the patient, and sometimes monovision with standard IOLs will suffice. The obvious disadvantages of monovision are difficulties with adaptation, loss of stereopsis, and the added chair time needed to explain it,” he said. Satisfaction rates In the 2014 ASCRS Clinical Survey, members were also surveyed about how satisfied they are with current presbyopia-correcting IOL options (Figure 2). On average, physicians think their presbyopia-correcting IOL patients are most satisfied with their distance vision at 1-year postop, with an average score of 8.3 on a scale from 1 to 10. More than half of surgeons gave their patients a score of 9 or 10 on their satisfaction with distance vision. Average U.S. 18.4% Non-U.S. 26.7% Overall 22.3% Average U.S. Non-U.S. Overall Near vision 7.2 7.6 7.4 Intermediate vision 6.2 6.0 6.1 Distance vision 8.3 8.2 8.3 Figure 1. The survey asked, “What percentage of your cataract cases do you target for monovision rather than implanting presbyopia-correcting IOLs?” Figure 2. The survey asked, “Overall, how satis ed are your presbyopia-correcting IOL patients with their outcomes at the following distances at 1-year postop?” (0=Least satis ed, 10=Most satis ed) Source (all): ASCRS Respondents said patients are least satisfied with their intermediate vision at 1-year postop, with an average score of 6.1, more than 2 points below distance vision. Fewer than 15% of respondents gave their patients a score of 9 or 10 on their satisfaction with their intermediate vision. The difference in responses between U.S. and non-U.S. surgeons was not statistically significant. “Multifocals typically have provided good distance and good near vision with weaker intermediate vision,” Dr. Dell said. “Until very recently, we have not had access to multifocals in the U.S. that provided good uncorrected intermediate vision. However, one of the newly approved versions of the TECNIS Multifocal [Abbott Medical Optics, AMO, Abbott Park, Ill.], the ZKB00 IOL, provides excellent vision at about 20 inches. The other newly approved Tecnis Multifocal IOL, the ZLB00 [AMO], focuses at about 16 inches.” Donald Serafano, MD , Eye Physicians of Long Beach, Long Beach, Calif., agreed with this assessment. “When multifocals came out there was a big effort to have good reading vision, and this sacrificed intermediate vision,” Dr. Serafano said. “Now, new multifocals are taking into account intermediate and are backing off on reading at 12 to 16 inches. When the ReSTOR 2.5 [Alcon, Fort Worth, Texas] becomes available in the United States, this will take into account patients who want intermediate.” Additionally, the new extended range of vision lens from AMO, the Tecnis Symfony, may offer