EyeWorld Asia-Pacific June 2018 issue

20 EWAP FEATURE September 2017 Dr. Devgan has tapered down his use of EDOF IOLs due to dys- photopsias experienced by some patients and what he describes as a relatively limited ability to deliver consistent near vision. As with any IOL, it’s also a matter of keeping patient expec- tations in check regarding use of glasses. “I remind patients that our goal is to decrease dependency on glasses, but no technology will guarantee that every patient will be free of glasses all the time,” Dr. Donaldson said. Cataract surgeons must con- tinually compare appropriate use of EDOF IOLs with multifocal IOLs. For patients who want both near and far vision without glasses, Dr. Devgan prefers monovision or mul- tifocal IOL use. Extended depth of focus IOLs also may not have as strong near vision compared with a multifocal IOL, Dr. Donaldson said. Targeting range of vision One pearl Dr. Donaldson has for achieving an ideal range of vision is to mix and match EDOF IOLs and multifocal IOLs. “I tend to use an EDOF IOL in the dominant eye to maximize the distance and intermediate and couple that with a Tecnis 3.25 add IOL [Johnson & Johnson Vision] in the non-dom- inant eye to increase near,” she said. “In my experience, monovi- sion does not work well with these lenses, and leaving the patient my- opic in one eye has a tendency to induce unwanted dysphotopsias.” Dr. Devgan targets 1 D of depth of focus at plano to achieve a near point of about 1 meter away. “Other factors such as ambient lighting, pupil size, and other corneal aberrations will affect this,” he said. “To increase the near vision will require the second eye to be aimed a little myopic, about –0.5 or so, which will then bring the near to about 67 cm in that eye.” “I aim for a plano distance visual result in the dominant eye with EDOF lenses, and if the pa- tient is happy with the mid-range and near vision, I will aim for the same result in the non-dominant eye,” Dr. Donnenfeld said. “How- ever, if the patient requests ad- ditional near vision, I will provide mini-monovision with the second cataract surgery.” In the latter eye, Dr. Donnenfeld aims for a refrac- tive result of –0.50 D. Although the Symfony is the only EDOF IOL available in the U.S. right now, there are additional ones under development from Carl Zeiss Meditec (Jena, Germany) and Alcon (Fort Worth, Texas), Dr. Donnenfeld said. EWAP Editors’ note: Dr. Donnenfeld has financial interests with Alcon, Carl Zeiss Meditec, and Johnson & Johnson Vision. Dr. Donaldson has financial interests with Alcon, Bausch + Lomb (Bridgewater, New Jersey), and Johnson & Johnson Vision. Dr. Devgan has no financial interests related to his comments. Contact information Devgan: devgan@gmail.com Donaldson: KDonaldson@med.miami.edu Donnenfeld: ericdonnenfeld@gmail.com B I OME C H AN I C S ME E T S T OMO G R A P H Y HEY CORVIS ST I just took a look at the tomography. These values call for caution. I don’t think I would operate. HI PENTACAM The biomechanics looks good, though. The cornea is very stable. I don’t see any problem with operating. O.K. TOGETHER NOW Tomography and corneal biomechanics together make the decision easier: Surgery could be an option. Corvis ® ST meets Pentacam ® : Combined measurement results for a safe decision on surgery OCULUS at the APACRS in Chiang Mai, booth #6. TIP: Join us at the Lunch Symposium on Thursday, 19th July 2018, 12:15 – 13:15 h OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 www.oculus.de • info@oculus.hk Finding a niche – from page 19 June 2018