EyeWorld India March 2020 Issue

FEATURE 10 EWAP MARCH 2020 would not be good candidates, he said. On a similar vein, corneal abnormalities related to ocular surface disease and dry eye would need to be addressed prior to assessing candidacy for this lens, according to Dr. Solomon. If a patient was very concerned about night vision symptoms, Dr. Yeu said she would consider the lowest-add multifocal or an EDOF IOL instead. Starting with a trifocal in the nondominant eye first is key in patients where dysphotopsias were of significant concern. See how they do postop, and treat the dominant eye accordingly. Dr. Donnenfeld said if a patient wanted to have the best possible distance vision, good intermediate, and were willing to wear glasses for near, he would still recommend an EDOF lens. However, if their goal is overall spectacle independence at all distances, he said he would offer trifocal technology. Tips for success The doctors noted how forgiving PanOptix seemed to be when slightly off target. Dr. Solomon specifically mentioned the defocus curves of the clinical trial data as evidence and compared this flexibility to that seen with EDOF technology. “Surgeons still need to be vigilant about getting refractive error as close to plano as they can,” he said, noting, however, that airing on the side of slightly hyperopic is yielding good results. Dr. Yeu said she uses 119.1 as her A-constant and the Barrett Universal for all axial lengths, comparing calculations with the Hill-RBF. She said she’ll start with the nondominant eye, aiming for the first minus of plano to nail both distance and range of near vision. In the dominant eye, she said she’ll aim for the closest to plano, even if it’s on the hyperopic side. Dr. Solomon said he continues to under promise and over deliver with these lenses. He also emphasized the importance of good preop measurements. He takes at least two biometry measurements using different devices as well as a topography. Overall, Dr. Cionni said he has been involved in many clinical trials for presbyopia-correcting lenses and has “never seen happier patients than I found with the patients I treated in the clinical trial.” “We always have to be careful in translating trial results to post- market approval outcomes but, thus far, the patients in whom we’ve implanted this IOL since approval are thrilled with their results,” he said. EWAP Editors’ note: Dr. Cionni is medical director of the Eye Institute of Utah, Salt Lake City, and has relevant financial interests with Alcon. Dr. Donnenfeld practices with the Ophthalmic Consultants of Long Island, is clinical professor of ophthalmology at New York University, Garden City, New York, and has relevant financial interests with Alcon, Bausch + Lomb, Johnson & Johnson, and Carl Zeiss Meditec. Dr. Solomon practices at Carolina Eyecare Physicians, Mount Pleasant, South Carolina, and has relevant financial interests with Alcon. Dr. Yeu is assistant professor of ophthalmology at Eastern Virginia Medical School, practices at Virginia Eye Consultants, Norfolk, Virginia, and has relevant financial interests with Alcon, Johnson & Johnson Vision, and Carl Zeiss Meditec. John Chang, MD Director, Guy Hugh Chan Refractive Surgery Centre Hong Kong Sanatorium & Hospital 8/F, Phase II, Li Shu Pui Block, Hong Kong Sanatorium & Hospital john.sm.chang@hksh.com ASIA-PACIFIC PERSPECTIVES M ultifocal IOLs have come a long way when I first implanted the Array and ReZoom trifocals. Pupil size was a very important issue. If a patient’s pupil was too small, they could not read, then came the ReSTOR lens that didn’t work well if the pupil was too large! Nowadays with the Panoptix and the EDOF, pupil is no longer an issue unless it is very large. Panoptix has an additional advantage that it has manipulated the diffractive light orders and managed to have 88% light transmission, which is the highest of all the trifocals. Although no one has studied this but I believe that the wasted light (12%) translates to glare, which is more annoying than halo! Because glare (waxy vision) is like looking through a soft lens and it is there all the time, whereas halo only occurs at night looking at lights in a dark environment. We found that that the glare score of Panoptix was as little as that of EDOFs which already have minimal glare. Because of the low glare score, we have been implanting this into post-LASIK eyes and the results are very encouraging. The intermediate sweet spot is 40 to 60 cm which is best for Asians, given the limited space we have, compared to other trifocals whose sweet spot is further which may be more appropriate for taller Caucasians. I use the Barret Universal formula and the Hill-RBF formula and have achieved excellent results. The Panoptix Toric is also as good as its monofocal toric counterpart, the rotational stability is excellent. For the Panoptix Toric, I use the Barrett K calculator formula which uses an integrated mean or median K from multiple instruments. In Asia, the toric version corrects down to +1.00 D astigmatism (which is TFNT20) as well as the T3-T6 versions available in the USA so there is no need to perform LRI anymore. We have achieved a high degree of accuracy with less than 1 % enhancement rate and 96% complete spectacle freedom (unpublished data). Patient should still be warned about the possible dysphotopsia (especially halo) and expectation should be lowered. “Underpromise and overdeliver” will give you very satisfied patients. Editors’ note: Dr. Chang has relevant interests with Alcon Laboratories, Carl Zeiss, Hong Kong Global Vision Ltd., and Johnson & Johnson.