EyeWorld India June 2019 Issue

EWAP JUNE 2019 51 REFRACTIVE lens trial, orthophoria, and weak to moderate ocular dominance. "VՏ>À `œ“ˆ˜>˜Vi ˆÃ `ˆvwVÕÌ Ìœ evaluate. Alternate dominance is better because of better interocular suppression, but it must be a weak dominance. The contact lens trial allows the patient to experiment with monovision in real world situations and can help reveal the preferred eye for each distance.” Crossed pseudophakic monovision for patients with a mild degree of anisometropic pseudophakia may work as well as conventional pseudophakic monovision, however, crossed monovision has more contraindications and should be avoided if the conventional technique can be performed, according to a retrospective Vœ“«>À>̈Ûi ÃÌÕ`Þ Ì…>Ì ˆ`i˜Ìˆwi` 30 patients who underwent crossed monovision from 7,311 cases of IOL monovision that were reviewed over 14 years. The study author concluded, however, that traditional monovision was still the most reliable method. 4 “The issue is still the choice between conventional versus crossed monovision,” Dr. Ribeiro said. “In crossed monovision, the dominant eye is set for near and the nondominant for distance. Pseudophakic crossed monovision can provide good patient satisfaction and spectacle independence. We have had good results with this. Conventional monovision is more popular today, and it may ‘protect’ distance vision and improve intermediate acuity, reducing the patient’s dependence on spectacles.” Dr. Ribeiro uses an approach ˆ˜ ܅ˆV…Ã…i “œ`ˆwià monovision with monocularly induced spherical aberrations, which increases the depth of focus and enhances binocular vision through focus visual performance. In the far eye, she corrects the spherical aberration and in the near eye, she either does not correct it or she induces more. This can be combined with EDOF lenses that are more tolerant to residual error than MIOLs. Defocus curves of EDOF lenses for intermediate vision are very good, she said. “The strategy for monovision with EDOF IOLs is to target emmetropia in the dominant eye,” she explained. “We see the postoperative evaluation, and if we have a good functional status, we replicate it in the second eye. If it needs more near, we can target the second eye for micro- monovision, or for even more near, we can use a bifocal in the second eye. Mix and match defocus curves in our patients are very good,” she said. “We are fortunate to have many solutions for the correction of presbyopia. Monovision is a satisfactory solution for select patients who cannot afford or may not be suited for MFIOLs. EDOF IOLs are suitable for micro-monovision and mix and match scenarios. The future may bring new IOL designs to further expand our options,” Dr. Ribeiro said. EWAP References 1. Xiao JH, et al. Pseudophakic monovision is an important surgical approach to being spectacle-free. Indian J Ophthalmol . 2011;59:481–5. 2. Hayashi K, et al. Optimal amount of anisometropia for pseudophakic monovision. J Refract Surg . 2011;27:332–8. 3. Greenbaum S. Monovision pseudophakia. J Cataract Refract Surg . 2002;28:1439–43. 4. Zhang F, et al. Crossed versus conventional pseudophakic monovision: patient satisfaction, visual function, and spectacle independence. J Cataract Refract Surg . 2015;41:1845–54. Monovision with EDOF IOLs. Source: Filomena Ribeiro, MD Appasamy Associates Page 19 www.appasamy.com Haag-Streit Diagnostics Page 2 www.haag-streit.com OCULUS Optikgeräte Page 12 www.oculus.de Santen Page 34 – 37 www.santen.com Singapore National Eye Centre Page 64 www.snec.com.sg VSY Biotechnology Page 17 www.vsybiotechnology. com Zeiss Page 20 – 23 www.zeiss.com.sg APACRS Page 5, 7, 8 – 9, 24, 27, 49, 71, 72 www.apacrs.org ASCRS Page 56 www.ascrs.org ADVERTISER LISTING