EyeWorld Asia-Pacific June 2018 issue

16 EWAP FEATURE June 2018 Crystalens implantation Source: Jack Singer, MD Dr. Weinstock said the best candidates are hyperopes who wear glasses all of the time and who have maximized their accom- modation over the years trying to fight their hyperopia and presbyo- pia. Good candidates are “people who are distance-oriented, want sharp, high contrast distance vision, like golfing and driving at night,” Dr. Weinstock said. “They appreciate the optics of the Crystalens. They tend to do better with the Crystalens than a multi- focal lens’ optics, which can create dysphotopsias at night and other unusual lighting conditions.” A key part of patient selection is looking at their lifestyle to help them make decisions about what kind of technology they would do best in, Dr. Weinstock said. Poor candidates for the accom- modating lenses, according to Dr. Lindstrom, include “those with poor visual potential, although accommodation would not hurt them. The cost benefit ratio would be poor.” Bad fits for the lenses, Dr. Weinstock said, include natural myopes who don’t have a lot of ac- commodation and who take their glasses off to read and use their natural myopia. “They don’t have a lot of ac- commodation because they’ve never had to use those muscles,” Dr. Weinstock said. “They are also used to good reading vision up close naturally, and the Crystalens doesn’t provide that, so they tend to be disappointed if their expecta- tions are not set properly.” People who have unusually long or short eyes can be challeng- ing for the Crystalens because of the flexible nature and size of the lens. “It’s designed more for the average-shaped eye rather than the extremes of shapes and sizes of eyes,” Dr. Weinstock said. Poor candidates also include those with any type of capsular instability related to trauma or a condition like pseudoexfoliation syndrome. “Those are not good candi- dates because the Crystalens is reliant on the capsule to be in good integrity, and it needs to be healthy for it to function and be stable in the eye,” Dr. Weinstock said. Targeted vision In the Crystalens, Dr. Weinstock almost always targets the domi- nant eye for plano and the non- dominant eye for –0.3 to –0.5, which allows a little more freedom from glasses without compromis- ing the distance vision. Dr. Yeu targets the non- dominant eye to –0.5 to –1.0. The variation depends on how the patient has performed with a trial monovision lens or prior use of monovision in a soft contact lens. She targets the dominant eye to plano. Dr. Lindstrom prefers a mono- vision approach, with one eye tar- geted to plano and the second tar- geted to –1.5 to –2.0. He also noted that mini-monovision works with the Crystalens. In those cases, he targets plano in one eye and –0.75 to –1.0 in the second eye. EWAP Editors’ note: Dr. Lindstrom has fi- nancial interests with Alcon, Allergan (Dublin, Ireland), Bausch + Lomb, Johnson & Johnson Vision (Santa Ana, California), Carl Zeiss Meditec (Jena, Germany), and Elenza. Dr. Yeu has financial interests with Bausch + Lomb, Carl Zeiss Meditec, Alcon, and Johnson & Johnson Vision. Dr. Weinstock has financial interests with Bausch + Lomb. Contact information Lindstrom: rllindstrom@mneye.com Weinstock: rjweinstock@yahoo.com Yeu: eyeulin@gmail.com Getting the most – from page 15