EyeWorld Asia-Pacific June 2018 issue

Considering premium IOLs for glaucoma patients by Liz Hillman EyeWorld Staff Writer AT A GLANCE • Patients with glaucoma or ocular hypertension with no visual field loss can be good candidates for presbyopia-correcting IOLs. • Provided there is no central vision loss, astigmatic correction can benefit patients with glaucoma. • Some MIGS procedures have been associated with myopic shift, and that should be considered when implanting a premium IOL. • The ocular surface should be appropriately addressed in patients with glaucoma receiving a premium lens. continued on page 32 September 2017 June 8 EWAP SECONDARY FEATURE 31 Glaucoma doesn’t necessarily exclude patients from presbyopia- correcting, toric IOLs W hen are glau- coma patients candidates for a presbyopia-cor- recting lens? When would a toric be appropriate? How could MIGS affect outcomes with these lenses? The general consensus is that in a patient with ocular hyper- tension or mild glaucoma with no visual field loss, a presbyopia- correcting lens could certainly be offered, provided the patient is a candidate for the lens on all other fronts as well. Toric IOLs, in the absence of central vision loss, could be offered to nearly all patients with glaucoma who also have astigmatism. “Just because someone has glaucoma doesn’t mean that you shouldn’t be committed to the highest level of refractive excel- lence for that patient,” said Steven Sarkisian, MD , clinical professor and glaucoma fellowship direc- tor, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City. Glaucoma and presbyopia- correcting IOLs In a review of premium IOLs for glaucoma patients, Ichhpujani et al. noted a “paucity of scien- tific evidence in the form of large trials on the impact of MFIOLs in glaucoma,” thus, the authors continued, “decisions regarding the implantation of a multifocal IOL in a glaucoma patient should be tailored as per the patient’s motivation and rate of progression in glaucoma.” 1 Dr. Sarkisian said he treats all patients with full visual fields like any other patient, regardless of their diagnosis with ocular hyper- tension, mild glaucoma, or glau- coma suspect. “I think that patients with ocu- lar hypertension or mild glaucoma who are well controlled and have full visual fields are reasonable candidates for presbyopia-correct- ing lenses,” he said. Valerie Trubnik, MD , Ophthalmic Consultants of Long Island, Mineola, New York, and Constance Okeke, MD , Virginia Eye Consultants, Norfolk, Virginia, took the same stance. “I only consider multifocal lenses in patients who have ocular hypertensive or early glaucoma with no visual field loss whatsoev- er,” Dr. Okeke said. “These patients still have a good chance of having an excellent outcome for the long term. With multifocal lenses, there is splitting of light through the lens, which decreases the transi- tion of light to the retina, so there is a contrast reduction. Patients who have glaucoma already have a reduction in contrast sensitivity. I discourage my glaucoma patients who have any kind of visual field loss from getting a multifocal lens.” Dr. Trubnik, Dr. Okeke, and Dr. Sarkisian said the Tecnis Symfony lens (Johnson & Johnson Vision, Santa Ana, California), as an extended depth of focus lens with different optical principles than other multifocal designs, could provide better contrast sensitivity for patients with glaucoma. Dr. Sarkisian also said he has implant- ed accommodative lenses (Crystal- ens, Bausch + Lomb, Bridgewater, New Jersey) in some patients with Trulign IOL in combination with the iStent, after aligning the axis of the IOL Source: John Berdahl, MD