EyeWorld India June 2021 Issue

EWAP JUNE 2021 3 EDITORIAL EyeWorld Asia-Pacific • June 2021 • Vol. 17 No. 2 Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific Abhay Vasavada Deputy Regional Editor EyeWorld Asia-Pacific M idway through 2021, the COVID-19 pandemic shows no signs of waning. This issue aptly highlights conundrums related to practice. Yet we adapt to changing situations—as has been the case with eye banking and corneal clinics the world over. New or modified safety protocols and guidelines allow vision rehabilitating surgeries for patients who need them the most. Virtual platforms and simulators keep corneal surgeons updated, enhance surgical skills and clinical knowledge. Virtual consultation ensures that patient care does not suffer. COVID-19 continues to force innovation. Experts discuss what they are doing additionally and what will become redundant in the wake of COVID-19. What stands out is following the basics of masking, good ventilation, the use of disposables, and managing patient flow. Technologies, particularly telemedicine, seem here to stay. Simultaneously, this issue focuses on newer IOL technologies for presbyopia correction and vision quality enhancement. There is a shift towards technologies that can allow patients a wider range of vision yet reduce the unwanted visual effects associated with multifocal/trifocal IOL technology. Astigmatism correction too has been in the spotlight and here again we have a plethora of options. We now have various technologies such as the OCT and wavefront aberrometry to help us design patients’ vision with unmatched accuracy. Nevertheless, we must not forget that the basic requirement remains a good technical outcome and tissue respect during surgery. The article on iris defects in cataract surgery is thus informative and insightful. Paying attention to comorbidities, especially in the retina, is crucial in preoperative decision making and postoperative management. It is especially important to rule out preexisting disease prior to cataract surgery; in this regard, I find the retinal OCT very useful and, wherever feasible, should probably become standard of care in every patient undergoing cataract surgery. As we bask in the success of refractive procedures, we must not forget to evaluate long-term complications. It is only through robust collection and analysis of data over several years that we will learn strategies to reduce or prevent these complications. Adapting to change and reflecting on the outcomes both good and bad are the keys to moving forward and emerging victorious. A mong the many interesting articles in our current issue “What’s new in the world of IOLs” is sure to be of interest. Several pseudophakic options are available to surgeons who would like to offer a solution to their patients’ presbyopia. My approach is to select the option that I believe has the greatest likelihood of success as defined by patients’ satisfaction, with the least amount of compromise in their quality of vision—modest monovison. The term monovision encompasses a wide range of myopic defocus in the near eye and the terminology can be confusing. I would suggest that the term mini monovision be used when the anisometropia is set at 0.75 D to 1.00 D; modest monovision at 1.25 D to 1.50 D; and traditional monovision at 1.75 D to 2.50 D. When even smaller amounts of myopic defocus such as –0.5 D or less are targeted in one eye then the term micro monovision would be appropriate. What’s new in world of IOLs, however, are extended depth of focus IOLs which are complementary to monovision. In recent years the term “extended depth of focus” has been applied to several IOLs based on different optical principles such as negative SA, low-add diffractive bifocal and trifocal IOLs, and phase shift technology. The term therefore does not describe a homogeneous group of IOL models and features such as the presence or absence of dysphotopsia depends on the optical principles. In addition, not all these IOLs are good for use in combination with myopic defocus as in monovision. Depending on the optical technology, even minor myopic defocus can increase unwanted images or compromise MTF. Modest monovision continues to be an attractive solution to presbyopia and, in my opinion, should be considered a “premium” solution. It requires expert surgery and biometry, knowledgeable selection of IOLs, and the utilization of toric implants to reduce astigmatism. The popularity of this approach is increasing, and when combined with extended depth of focus IOLs could increase spectacle independence while avoiding some of the negative issues associated with multifocal IOLs. EWAP