EyeWorld India March 2020 Issue

Who is suitable for TECNIS Eyhance™? What A- constant should be used? What is the refraction goal? What is the best way of achieving a maximum plus refraction? Why not autorefractor? Patients for whom a monofocal IOL is being considered. A-constant recommendations are 119.3 for optical biometry and 118.8 for ultrasound. For best possible outcomes, surgeons should personalize their A-constant based on their refractive outcomes using the maxi- mum plus technique Performing “maximum plus” refraction is strongly recommended. Pushing plus helps maximize both distance and intermediate vision with this IOL technology This consists of refracting patients with the maximum plus (or least minus) power through which the best distance visual acuity is achieved. This refraction procedure is similar to that used for young phakic patients, that still retain their accommodation. • Measure UCDVA • Start with +0.75D using a phoropter or trial lens • If VA drops 1 line over UCDVA, add -0.25D lenses until patient achieves best VA (+0.75 -> +0.50 -> +0.25 -> PL -> -0.25 ...) • If VA drops less than 1 line over UCDVA, add an additional +0.75D • Best VA is reached when patient no longer sees more letters after adding -0.25D For optimal outcomes, cylinder should be addressed similar to monofocal IOLs. Standard autorefractors use the central part of the eye to esti- mate refraction. Due to the continuous change in power from the center to the periphery of TECNIS Eyhance TM IOL, autore- fractors may provide a wrong estimation of the total power of the eye. Clinical pearls for optimizing outcomes with TECNIS Eyhance™ KEY CONSIDERATIONS WITH TECNIS EYHANCE TM FOR OPTIMAL OUTCOMES 8 GETTING THE BEST OUT OF TECNIS EYHANCE TM IOL IN PRACTICE The real-world experiences shared by the experts indicated favourable vision outcomes and patient satisfaction – driven by the ability to perform daily and social tasks that require intermediate vision. For those patients seeking freedom from spectacle use, the experts ex- pressed preference for presby- opia-correcting IOLs. However, if spectacle-freedom is not a patient’s priority, then the experts agreed that TECNIS Eyhance TM would be an appro- priate choice. Understanding patients’ goals and preferenc- es, which in turn determines the clinical goals, is instrumen- tal in determining the most appropriate choice of IOL. Discussion on the choice of target for the IOL calculation (plano, first plus or first minus), led some experts to explain how a target of PL is a support- ed concept in young patients, although for the older patients, the target is more commonly -0.5 D. However, due to the strong need to retain near vision in the Asian context, there was debate for select- ing the first minus closest to emmetropia. A few experts believed that targeting minus for TECNIS Eyhance TM is likely to boost it by 0.5 diopter while still retaining distance vision. In the context of bilateral cataract surgery, the choice of target would depend on what has been inserted and achieved with the first eye. Figure 3 illustrates the importance of se- lecting the right IOL power to achieve the desired outcomes. The post-operative outcomes should be verified using the maximum plus refraction tech- nique in order to unmask the high tolerance of this lens.