EyeWorld India December 2021 Issue

CATARACT EWAP DECEMBER 2021 13 you can take it away without having to do an invasive surgical procedure.” He also said that the LAL is a “game changer in operating on prior LASIK eyes and PRK eyes” because you don’t have to overthink the lens implant calculation. You just have to get close with the IOL and let the adjustments do the rest. “It’s dramatically improved patient satisfaction for us in post-LASIK eyes,” he said. “It used to be that on a prior LASIK eye, if the patient wanted a premium product, we had to tell them the chance of having to go back in and do a touch - up was 50–80%, we’re not doing the touch -up until 2 months out, and it would have to be PRK rather than LASIK.” Deborah Ristvedt, DO, thinks that the LAL came at “a great time where we’re really focusing on precise results and good outcomes for patients.” She uses the lens frequently in post-refractive patients. “It’s nice with this technology where we’re doing all the treatments post - healing,” she said. Additionally, she said it’s a great option for patients with astigmatism. Torics correct astigmatism, but there is still some variability with corneal healing and effective lens position. “I’ve found that to be able to really dial in astigmatism, knowing exactly what axis we’re treating, gave me more confidence that I was going to nail the target every time,” Dr. Ristvedt said. “I’ve found that I’m doing a lot of mini-monovision as well to give patients more extended range of vision.” Patient discussion When discussing the LAL as an option with patients, Steven Naids, MD, focuses on a couple of things. First, he explains that while the surgery is the same as with regular cataract surgery, the recovery is quite different. “I always tell patients that before this, the lens that was put in the eye is what you got, and the recovery was just drops,” he said. “Now, compliance is what matters with the UV glasses. It’s an enormous commitment for the patients to wear the glasses for 6– 7 weeks.” You have to get a good feel for the patient and their lifestyle, he said. Dr. Naids noticed that with more people working from home during the pandemic, they seemed a little more comfortable wearing the glasses at home rather than the workplace. “We talk about how much work is involved on their end,” he said. “Then we talk about how that is all for long-term gain. In general cases, accuracy is around 60–70%, but now we’re upward of 90%,” he said. “With every cataract consultation that comes through the doors, we’re always getting biometry and topography,” Dr. Ristvedt said. “We make sure that we’re honing in on technologies where we can start to sort out who are good candidates for different refractive IOL technologies.” She added that she likes to look at the ocular surface and do an osmolarity test, helping identify dry eye, corneal irregularities, higher order aberrations, etc. “The patient can become confused if we give them too many options,” Dr. Ristvedt said. She likes to keep it simple and ask the patient “How do you want to use your vision?” This helps determine if the patient wants to wear glasses or be less dependent or if the patient prefers to see at distance; distance and intermediate; or distance, intermediate, and near. “I’ve found that with the LAL, I’m using it on patients who want good distance or to correct astigmatism.” When talking to patients about the LAL, Dr. Chang compares it to putting a golf ball, explaining that IOL power selection requires assumptions and estimates, and he cannot guarantee hitting the target with a single putt. “The LAL gives me three putts, which effectively allows us to also change the target (e.g., the amount of myopia in the second eye) based on the patient’s postoperative experience and function,” he said. Workflow challenges and differences from other IOLs One major difference that Dr. Chang explained is that he offers every bilateral LAL patient the option of immediate sequential bilateral cataract surgery (ISBCS). “By adjusting both eyes simultaneously postoperatively, they are typically returning the same number of times that immediate sequential patients are for non - adjustable IOLs,” he said. Dr. Naids noted the importance of having an excellent support staff when doing these cases. You have to have a close team of optometrists and ophthalmologists working together on this, he said, because patients will spend about 2 hours in the office for each treatment. If you have a post-refractive eye, Dr. Loden said your workload is going to be better than doing a PRK touch - up on top of a LASIK flap. There is less overhead and faster recovery of vision, he said. But compared to a standard toric lens or standard extended depth of focus lens that you might put in, Dr. Loden said there is an increased workload. “It’s going to take three extra visits to do adjustments and