FEATURE 18 EWAP MARCH 2022 corrections are at greater risk of dysphotopsias with a presbyopia-correcting IOL but I have found do well with the lowadd refractive EDOF Vivity and Eyhance lenses.” Toric IOLs, which are still out of pocket and considered premium IOLs, are far more forgiving in the face of other ocular conditions. In fact, Dr. Scoper said the only contraindication to toric IOLs is not having astigmatism. Dr. Donnenfeld said that patients with treatable corneal disease, such as EBMD or pterygia, should have this addressed first, be given time to heal/stabilize, then have measurements and selection of a toric IOL. “The specific condition that is a contraindication to a toric IOL is patients who wear a gas permeable or scleral contact lens for visual rehabilitation. Placing a toric IOL will place the cylinder in the eye and not allow it to be treated with a rigid contact lens,” Dr. Donnenfeld said. usually I like to wait 6 weeks for the cornea to fully remodel,” she said, adding that some physicians may choose to wait 2–3 months. She also alerts patients that if they still have irregularity on topography, the wait may be longer. Dr. Houser added that this is also a condition that can recur, though she said patients usually don’t need retreatment for some time. “It’s rare that I have to do retreatments within several years,” she said. Dr. Thompson added that after doing epithelial scraping or PTK, it can take about 3 months for best vision to be restored. Dr. Marvasti said for a patient with EBMD with multiple recurrences of corneal erosion or those with the dystrophy affecting the visual axis, he will typically recommend epithelial debridement with diamond burr polishing. “This treatment has worked the best for my patients, especially after failing other more conservative options,” he said. “The healing time can range from weeks to 1–2 months.” Generally, Dr. Marvasti said he starts with more conservative treatment options, which can include ocular surface optimization with ocular lubricants, nighttime lubricating ointments, serum tears, amniotic membrane, hypertonic saline solution or ointment, bandage contact lens, and topical antibiotics for corneal erosions. Identifying EBMD - from page 23 Finally, Dr. Williamson emphasized the importance of having the right toolkit preoperatively and diagnostically in order to confidently recommend advanced technology lenses. He said topography, an updated biometer, and OCT of the macular are important. He also stressed the importance of refractive touch-ups when needed or IOL explants when necessary. “These lenses aren’t for everyone. … If you have good skills for doing a lens exchange, that’s an insurance policy. You know in the back of your mind that if everything else fails, … you have the tools to get that lens out,” he said. EWAP Editors’ note: Dr. Donnenfeld is in practice with Ophthalmic Consultants of Long Island, )arden City, New York, and has interests with Alcon and ,ohnson & ,ohnson Vision. Dr. Scoper is in practice with Virginia Eye Consultants, Norfolk, Virginia, and has interests with Alcon. Dr. Williamson is in practice at Williamson Eye, $aton Rouge, Louisiana, and has interests with ,ohnson & ,ohnson Vision. Surgical options, he said, include epithelial debridement with or without diamond burr polishing, PTK, and stromal micro-puncture. He again stressed that he typically uses epithelial debridement with diamond burr polishing for someone who has failed with more conservative options. Dr. Marvasti noted that recurrence after surgical intervention is low, adding that he has not personally seen someone with recurrent corneal erosions after a thorough epithelial debridement with diamond burr polishing. “The main point is always having a high degree of suspicion for EBMD in someone with fluctuation in vision, monocular diplopia, or anyone seeking to have cataract or refractive surgery,” Dr. Marvasti said. “As one of my mentors told me, ‘You’ll miss it if you don’t look for it.’” these types of patients.” EWAP Editors’ note Dr. Houser is in practice at Duke 7niversity, Durham, North Carolina, and declared no relevant financial interests. Dr. Marvasti is in practice with Coastal Vision Medical )roup, Irvine, California, and declared no relevant financial interests. Dr. 6hompson is in practice at Vance 6hompson Vision, SiouZ Falls, South Dakota, and has interests with Alcon, $ausch LomD, Carl <eiss Meditec, and ,ohnson & ,ohnson Vision.
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