EyeWorld India June 2019 Issue

EWAP JUNE 2019 47 FEATURE A s an increasingly popular option for presbyopia correction, extended depth of focus (EDOF) " à “ÕÃÌ Vœ˜Ìi˜` ܈̅̅i challenges facing all premium " ð /œ `>Ìi] «Ài“ˆÕ“ " à have tended to be less than ideal options for non-routine cases. Given that the target «œ«Õ>̈œ˜ Vœ˜ÃˆÃÌà È}˜ˆwV>˜ÌÞ of aging and elderly eyes, it is not uncommon for these eyes to be complicated by comorbid conditions such as glaucoma or by previous refractive surgery. EyeWorld corresponded with Daniel Chang, MD , cataract and refractive surgeon, Empire Þi E >ÃiÀ i˜ÌiÀ] >ŽiÀÃwi`] California, James Loden, MD , founder and president, œ`i˜ ˆ6ˆÃˆœ˜ i˜ÌiÀÃ] Nashville, Tennessee, Shannon Wong, MD , CEO Austin Eye, clinical assistant professor of ophthalmology, The University of Texas at Austin Dell Medical School, Austin, Texas, and Elizabeth Yeu, MD , assistant professor of ophthalmology, Eastern Virginia Medical School, œÀvœŽ] 6ˆÀ}ˆ˜ˆ> ̜ w˜` œÕÌ how the lenses have fared against such conditions in their respective practices. EDOF in complicated eyes Despite their superior light transmission and visual quality, surgeons should still exercise caution when considering EDOF " à vœÀ Vœ“«ˆV>Ìi` iÞið º Ì ˆÃ Ã̈ ˆ“«œÀÌ>˜Ì ̜…>Ûi >˜ œÛiÀ>…i>Ì…Þ iÞi] >˜` do not place either the Tecnis Symfony [Johnson & Johnson Vision, Jacksonville, Florida] or “Տ̈vœV> " à ˆ˜ >˜ iÞi ̅>Ì has macular drusen or ERMs,” Dr. Yeu said. She still considers both " >˜` “Տ̈vœV> " à vœÀ glaucomatous eyes that have ˜œ ۈÃÕ> wi` œÃà >˜` >…i>Ì…Þ ocular surface, but only an " " p«œÃÈLÞ Vœ“Lˆ˜i` ܈̅> Vœ˜Vœ“ˆÌ>˜Ì - procedure—if there is some OSD as is common in stable early to moderate primary open >˜}i }>ÕVœ“>° º `œ ̅ˆ˜Ž ̅>Ì Ì…i -ޓvœ˜Þ " ˆÃ “œÀi Àiȏˆi˜Ì ̜ ۈÃÕ> yÕVÌÕ>̈œ˜Ã >ÃÜVˆ>Ìi` with OSD,” she said. Dr. Chang considers EDOF " à > «œÌi˜Ìˆ> Li˜iwÌ Ìœ Ìܜ kinds of “complicated” eye. First are eyes with refractive complications such as OSD, anterior basement membrane dystrophy, corneal scarring, and post-refractive corneas. “Since " " à «ÀœÛˆ`i > LÀœ>`iÀ focal range than monofocal " Ã] ̅iÞ V>˜ Li >`Û>˜Ì>}iœÕà when refractive targeting >˜` ÃÌ>LˆˆÌÞ >Ài `ˆvwVՏÌ]»…i Ã>ˆ`° º7ˆÌ…Ì…i -ޓvœ˜Þ " ] vÀiµÕi˜ÌÞ >ˆ“ ψ}…ÌÞ Hä°x D) plus to left-shift the defocus VÕÀÛi] ̅Õà Ṏˆâˆ˜} ̅i `i«Ì…œv focus for refractive stability (of distance vision) instead of range of vision.” Second are eyes with sensory complications such as epiretinal membranes, macular degeneration, and glaucoma. º œÀ >˜ " " ̅>Ì «ÀœÛˆ`ià image quality and contrast comparable to a monofocal, ˆŽi ̅i -ޓvœ˜Þ] Ã̈ œvviÀ ˆÌ to these patients,” he said. He offers a surgical option since other solutions for presbyopia such as bifocal glasses can increase the elderly’s risk of ÌÀˆ«Ã >˜` v>Ã° º `œ “>Ži ˆÌ clear to these patients that if their pathology progresses, their visual quality could likely `iVÀi>Ãi Ài}>À`iÃà œv ̅i " they receive.” “Because the EDOF lens performs similarly to a monofocal lens in eyes with coexisting corneal, retinal or optic nerve pathology, we use EDOF lenses in these patients but counsel them extensively preoperatively about what to expect,” Dr. Wong said. “Usually patients with an EDOF lens and coexisting macular pathology do not read up-close as well as EDOF patients with normal maculas. The far vision seems to be equivalent to a monofocal lens in patients with macular pathology.” Challenging EDOF: Extended depth of focus IOLs in non-routine cases by Chiles Aedam R. Samaniego Þi7œÀ` čÈ>‡*>VˆwV Senior Staff Writer 'FKVQTUo PQVG &T %JCPI JCU KPVGTGUVU KP #EW(QEWU +TXKPG %CNKHQTPKC CPF ,QJPUQP ,QJPUQP 8KUKQP &T .QFGP CPF &T 9QPI JCXG KPVGTGUVU KP ,QJPUQP ,QJPUQP 8KUKQP &T ;GW JCU KPVGTGUVU KP #NEQP (QTV 9QTVJ 6GZCU ,QJPUQP ,QJPUQP 8KUKQP CPF %CTN <GKUU /GFKVGE ,GPC )GTOCP[ Contact information %JCPI | dchang@empireeyeandlaser.com Loden: lodenmd@lodenvision.com Wong: shannon@austineye.com Yeu: eyeulin@gmail.com AT A GLANCE • EDOF IOLs still require caution when being considered for complicated eyes, although the broader focal range confers a number of advantages, particularly in cases where refractive targeting and stability are issues. • EDOF IOLs can be used successfully for refractive lens exchange, but it must be made clear to patients that even these lenses may not be able to replicate the full visual acuity and quality of their crystalline lenses. • As always, preop counseling is essential in managing unhappy patients receiving EDOF IOLs. Symfony IOL in an eye with 12-cut RK. Source: Shannon Wong, MD 6JKU CTVKENG QTKIKPCNN[ CRRGCTGF KP VJG #RTKN KUUWG QH EyeWorld . It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU JGTG YKVJ RGTOKUUKQP HTQO VJG #5%45 1RJVJCNOKE 5GTXKEGU %QTR CAT RACT