EyeWorld India December 2021 Issue

18 EWAP DECEMBER 2021 modern trifocal lens gives a real chance of freedom from glasses at all ranges, though with some cost in quality due to all multi- and trifocal lenses having to split light. Thus, extended depth of focus (EDOF) lenses are the “in-betweeners.” Dr. Lawless stated that “until the Vivity™ IOL, you had to accept a compromise. I had to choose what mattered most to the patient and make some nu- anced decisions.” Now with the Vivity™ IOL, the options for both surgeon and patient have expanded. The Vivity™ IOL extends the range but retains good, clear optics while offering a seamless transition so that patients do not have to “hunt for the correct focus point.” In Dr. Lawless’s consult- ing room, he has choices to make with the Vivity™ IOL. One choice is to aim for normal vision in both eyes (i.e. emmetropia with no refractive error), which will give the best unaided distance while retaining normal binocularity and depth perception. Another choice is to achieve a slight offset in the non-dominant eye. Dr. Lawless, with this choice, will aim for normal distance vision in the domi- nant eye and a small amount of short-sightedness (about -0.25 to -0.75D) in the other eye. This choice gives the patient a good chance of not needing glasses, though the surgeon cannot always promise that. “Some peo- ple will still wear glasses for some near tasks, but they won’t be as dependent on them” says Dr. Lawless. The important thing Dr. Lawless stressed with this choice is that it does not behave as monovision. Both eyes are working together and the extended range of the Vivi- ty™ IOL allows for a “visual summation” to create a very natural type of vision. Dr. Lawless also explained that the quality of vision and photic phenomenon is equivalent to a monofocal IOL. Additionally, there is a seamless transition from far to intermediate vision. A slight myopic offset in the non-dominant eye also allows patients the spectacle independence they wish for. “In my experience, this is the first time a lens has been able to provide all of the above.” The Full Range of Vision Option Abhay Vasavada, MD, India When talking about the full range of vision, trifocal IOLs came into the scene to tackle the issue of correcting intermediate vision in pa- tients at an 80 cm distance. For the Asian patient pop- ulation, intermediate vision may be too far for the aver- age Asian arm span, thus the PanOptix ® Toric Trifocal IOL was introduced to solve this problem. The PanOptix ® IOL provides intermediate vision at 60 cm instead of 80 cm while providing minimal loss of light to the retina at 3 mm pupil. Dr. Vasavada stated that the customization of outcomes for patients is important, and surgeons must have a very good understanding of the eye while also understand- ing the patient and his or her lifestyle. “Questionnaires are a very important tool in judging a patient’s lifestyle for choosing a made-for-you IOL,” says Dr. Vasavada. Case presentation with implanted binocular PanOptix ® Toric IOL. Safety outcomes were positive with more than 88% of sub- jects having no visual disturbances after AcrySof IQ Vivity ® IOL implantation. One case Dr. Vasavada presented was of an active 80-year-old female patient with a mainly indoor lifestyle and an enjoyment for read- ing, though she would often forget where she placed her reading glasses. The patient stated that she would love to get rid of glasses. After examining her ocular profile, Dr. Vasavada determined that she was a suitable can- didate for a multifocal IOL and recommended bilateral PanOptix ® IOL and advised the patient, after surgery, to read with sufficient light sources. Post surgery, the patient was very happy and achieved spectacle indepen- dence. What Dr. Vasavada learned from this case is that “age is not a ‘bar’ for the PanOptix ® IOL. In fact, it improves the quality of life of senior citizens.” Another case Dr. Vasavada presented was a 35-year- old male engineer with blurred vision and glare at night while riding his mo- torcycle. His ocular profile showed mild myopia at -1.5 diopters and posteri- or subcapsular cataract in both eyes. The patient also reported working for sev- eral hours at night on the computer. When Dr. Vasa- vada discussed IOL types with the patient, the patient reported that his friends had warned against multifocal IOLs, though he wished to get rid of his glare. Thus, Dr. Vasavada prioritized the Horses for Courses: Using the Right IOL for the Right Eye