EyeWorld India June 2019 Issue

64 EWAP JUNE 2019 DEVICES patient has a healthy macula, and that’s why doing an OCT is so important. Of course, we also need to be able to enhance the patient’s cornea with PRK or LASIK to optimize the optics to plano. That is why a corneal refractive workup needs to be a part of any premium implant evaluation. We don’t want to have a patient with residual refractive error postoperatively who we can’t enhance with the laser because they have a topographic irregularity or other contraindication to a >ÃiÀ w˜i Ì՘i° 7i Ü>˜Ì ̜ w˜` these issues preoperatively and do a monofocal IOL in these situations. But as long as the Ìi>À w“] VœÀ˜i>] >˜` “>VՏ> are healthy and the posterior capsule is clear after implant surgery, whether it took a capsulotomy or not, and the refractive error is near plano with or without an enhancement, this adds up to extremely high patient satisfaction,” Dr. Thompson said. Dr. Neuhann agreed. “I would not use them in patients with additional contrast lowering and/or light dispersion conditions, such as corneal guttata, pronounced dry eye, prior corneal laser vision correction with imperfect contrast sensitivity, and/or light phenomena,” he said. He advised extreme caution with prior low myopes. “Their lifelong excellent uncorrected near vision and, consequently, expectation is a great danger for disappointment with the near vision with such lenses,” he said. Pearls Dr. Thompson explains to patients that achieving the desired outcome is a four-step process. First is the implantation of the advanced trifocal, bifocal, or extended depth of focus implant. Second, 3 months later, if there’s any residual refractive error, an enhancement is performed using PRK or LASIK. Third, if the posterior capsule develops opacity a YAG laser is performed. More YAGs will be performed because a subtle posterior capsule opacity can degrade the optics of the implant more quickly than a monofocal implant. Fourth is neural-adaptation. “After the implant is in, the refractive error minimized with > w˜i Ì՘i œÀ ̅i «>̈i˜Ì i˜`i` up plano, and the capsule lasered, patient satisfaction at a month is quite high but even higher at a year,” Dr. Thompson said. “I tell patients that we’re embarking on a year-and-a- half journey together and that they’ll most likely experience some impressive improvements along the way, but at the end of that year and a half, they’ll have some of the world’s most advanced optics in their eyes to help them do a lot without glasses at multiple distances for the rest of their life. The patients that go into it with this attitude do beautifully.” Dr. Berdahl agreed. “I think we’re seeing the continued improvement of presbyopia- correcting IOLs in an iterative fashion because of all the experience that we’ve had with them, and it’s great to be part 110mm x 160mm of an innovative profession that’s getting better every day,” he said. The future Dr. Neuhann said he doesn’t see a future for bifocals. “When a multifocal is the option, use a trifocal. I do not see a place for bifocals anymore. Trifocals offer everything a bifocal can plus the intermediate vision at no extra expense. Realize—and make patients realize—that with presbyopia, everything is a compromise. We have the privilege to have multiple compromises available, with different advantage/disadvantage «ÀœwiÃ] ̜ V…œœÃi vÀœ“° ÕÌ Üi must never forget that they are all compromises. We do not have the option that everyone wants, namely, ‘back to youth’ vision with accommodation,” he said. EWAP