EyeWorld Asia-Pacific June 2018 issue

June 2018 EWAP REFRACTIVE 53 Views from Asia-Pacific Hyperopic patients did slightly better with a multifocal intraocular lens, but most out- comes were similar. Source (all): Steven Schallhorn, MD Schallhorn said, adding that this will have a greater impact on the IOL power calculation when the patient eventually has a cataract procedure. “There will likely be more variability in the post- cataract refraction if LASIK was previously performed on a high myope,” he said. “On the other hand, patients will generally have less visual symptoms and a little higher 3-month postop satisfaction if LASIK monovision is performed, and there will be less risk of a reti- nal detachment.” Overall, Dr. Schallhorn thinks that with the current technol- ogy of monovision LASIK versus multifocal IOLs, there are inherent trade-offs. “A multifocal IOL pro- vides good monocular near vision and distance vision; the trade-off is night visual symptoms,” he said. For LASIK monovision, the near eye has blurry distance vision and the distance eye is blurry at near. “There are trade-offs that have to be made in the decision of how to correct presbyopia in a patient who desires correction,” Dr. Schallhorn said. “It is important that the patient understands these and chooses a procedure that best meets his or her needs and expec- tations.” EWAP Reference 1. Schallhorn SC, et al. Monovision LASIK versus presbyopia-correcting IOLs: com- parison of clinical and patient-reported out- comes. J Refract Surg. 2017;33:749–758. Editors’ note: Dr. Schallhorn has financial interests with AcuFocus (Irvine, California) and Carl Zeiss Meditec (Jena, Germany). Contact information Schallhorn: scschallhorn@yahoo.com WANG Zheng, MD Guangzhou Aier Eye Hospital 191 Huanshi Zhong Road, Guangzhou, China gzstwang@gmail.com T he great success in refractive surgeries for myopic correction has inspired people’s hope for surgical correction of presbyopia. Many efforts have been made in the past two decades. Almost every excimer laser manufacturer has launched its presbyopia-correcting software. However, though many surgeons claim their good results with these software at meetings and personal communications, very few scientifically well-designed studies have been published in peer-reviewed journals. Is a corneal or an intracorneal approach the future of presbyopia surgery? I believe it is the latter. Most corneal presbyopia surgeries (except Kamra, which is a pinhole corneal inlay) utilize the fact that the depth of focus is extended if a certain amount of higher-order aberrations are introduced while maintaining an acceptable visual quality. However, the amount of HOA is critical. We all know that too much HOA will deteriorate the visual quality. But how much is too much? It can be different from patient to patient. What makes things even more complicated is that the sophisticated target corneal shape cannot be easily achieved because of many unpredictable factors such as corneal biomechanics and postoperative epithelial remodeling. “ Is a corneal or an intracorneal approach the future of presbyopia surgery? I believe it is the latter. ” - Wang Zheng, MD Several new designs of presbyopia-correcting IOLs have been developed in recent years. The Tecnis Symfony used in Dr. Schallhorn’s study is one of them. However, the results of the study are quite surprising. Its performance in the real world is very similar to that of the classic monovision approach, with even more night visual problems than monovision. The study results suggest that monovision LASIK still has an important place in the correction of presbyopia. In fact, this relatively simple procedure has another advantage in that it can be easily converted to standard LASIK if the patient is not happy with the result, without causing severe visual quality issues. This feature is important for future cataract surgery. This study provides us some useful information for choosing procedures for presbyopia correction. There are significant trade-offs with all current presbyopic surgries. We still have a long way to go towards the Holy Grail. Another important thing about presbyopic surgery is the management of patient’s expectations. Usually presbyopic patients require more chair-time before and after surgery. Careful patient selection and adequate consultation will improve patient satisfaction. Editors’ note: Dr. Wang is a consultant for Alcon (Fort Worth, Texas).