EyeWorld India March 2017 Issue

54 EWAP DEVICES March 2017 been “discouraged initially” with multifocal lenses because of the contrast sensitivity issue in high scotopic and mesopic conditions and the inability to function with intermediate vision. But he’s a firm advocate for trifocal lenses. “They appear to be an extremely good solution for a significant number of patients who require or would benefit from spectacle independence due to lifestyle or preference,” Dr. Kanellopoulos said. Patient selection pearls Patient selection was deemed a crucial aspect when considering multifocal or accommodative lenses, but those kinds of strict criteria “usually applies to technologies that are not intended for mass adoption,” Dr. Kanellopoulos said. “In my hands, trifocal lenses are a product that could be offered to almost every patient with minimal disadvantages.” Dr. Mertens recommends surgeons apply the same caution in a potential trifocal patient as they would a multifocal patient. “This includes a thorough anamnesis with the lifestyle of the patient, determining his/her expectations and motivation—all of these are still key to success,” he said. As with any refractive cataract patient, he also advises checking for dry eye or corneal issues. Treating the ocular surface before surgery is necessary regardless of the type of lens, but may be even more important with enhanced technologies. “Are there retinal problems such as drusen or diabetes? In the latter case, this is a relative contraindication and should be discussed in depth with the patient,” he said. “The higher the patient satisfaction, the better ambassadors they’ll be for your practice.” For Dr. Assia, patient selection, indications, and contraindications for trifocals are generally similar to bifocals, however, “since clinical results are superior, the selection criteria for trifocals is slightly more liberal than bifocal lenses.” Dr. Cummings will “routinely” perform a multifocal contact lens trial on potential candidates, and “if patients like the contact lens trial, I am confident that they will like the trifocal IOL—especially if they have stated that their intermediate vision is much more important than their near vision.” From a surgical standpoint, he recommends surgeons ensure that pupils are mobile and “not tonic and miotic.” While these lenses are still in their infancy, they seem to be on the verge of overcoming most patient complaints with other high technology lenses. “I think the future will surprise most clinicians in the trifocals’ ease of use and their potential advantages in enhancing and transforming cataract surgery into a supreme refractive surgical procedure with superior outcomes,” Dr. Cummings said. EWAP Editors’ note: Dr. Cummings has financial interests with Alcon. Dr. Mertens has financial interests with PhysIOL. Drs. Assia and Kanellopoulos have no financial interests related to their comments . Contact information Assia : assia@netvision.net.il Cummings : abc@wellingtonclinic.com Kanellopoulos : ajkmd@mac.com Mertens : e.mertens@medipolis.be Trifocals - from page 53 CALENDAR OF MEETINGS 2017 DATE Meeting VENUE May 5-9 ASCRS-ASOA Symposium and Congress (ASCRS) www.ascrs.org Los Angeles USA June 1-3 30th Asia-Pacific Association of Cataract and Refractive Surgeons Annual Meeting (APACRS) www.apacrs.org Hangzhou China June 23-25 32nd Annual Meeting of the Japanese Society of Cataract & Refractive Surgery (JSCRS) www.jscrs.org Fukuoka Japan October 7-11 XXXV Congress of European Society of Cataract and Refractive Surgery (ESCRS) www.escrs.org Lisbon Portugal November 11-14 Annual Meeting of American Academy of Ophthalmology (AAO) www.aao.org New Orleans USA