In terms of decentration, AcrySof IQ Vivity® is a more forgiving lens as compared to other presbyopia correcting IOLs, according to Dr. Lee Hung Ming. He presented the case of a 50-year old gentleman with high hyperopia of +3.5 in the right and +3.75 in the left eye, and 1D of cylinder in both eyes. Pentacam examination gave normal results and cylinder power was calculated using a Barret formula for toric calculation. Vivity® was implanted bilaterally at an interval of two days in between eyes. Postoperatively, Dr. Lee noticed that the lens was decentred by 1 mm in the right eye. Visual outcomes, however, were minimally affected. In both eyes, 20/20 distance vision and 20/40 reading vision were achieved. Intermediate vision in the right eye, where the IOL was decentred, was 20/40, as compared to 20/25 in the well-centred eye. The patient reported no difference between the right and the left eye in terms of glare, halos, starbursts or night vision, and said to be very satisfied. AcrySof IQ Vivity® can be effectively combined with a monofocal lens in the contralateral eye, according to Dr. Godfrey Lam. He implanted Vivity® in the left eye of a patient previously implanted with a Clareon monofocal in the right eye. He was a carpenter and he needed good intermediate vision for his work. Eventually, this patient was able to see 20/20 at distance, 20/50 at intermediate and near, and to work without spectacles. Equally good results were obtained in a lorry driver previously implanted with a Clareon in the left eye. This patient wanted to see intermediate and maintain long-distance vision in the left eye for driving as well. Dr. Lam’s first choice was a Vivity® +15.5D for the right eye. A decision that led to a positive outcome, with 20/20 distance and very good intermediate vision, a slightly underperforming near vision but, most importantly, no visual disturbances during night driving. As part of his early experience with AcrySof IQ Vivity®, Dr. Chandrasekar Wavikar asked detailed feedback from his patients, and the response was overall very positive. For reasons that are still unclear, some of his patients had better near outcomes than others, but after prolonged reading time they tended to develop eyestrain-related symptoms. A case reported during the meeting was that of a 48-year old patient with posterior subcapsular cataract in both eyes, and an abnormal angle alpha of 0.78. Dr. Wavikar said that he was initially sceptical about using Vivity® in this patient, despite being told that the lens technology is expected to be less dependent on angle alpha than diffractive IOLs. However, results after the first implant were extremely encouraging, and Vivity® was therefore implanted also in the second eye. The patient achieved 20/13 UCVA in both eyes individually, N8 uncorrected intermediate and N5 near vision, he reported. Dr. Lee Hung Ming, Asia Pacific Eye Centre, Gleneagles Hospital, Singapore Dr. Godfrey Lam, I Centre, Hong Kong “Decentration of a multifocal IOL can affect not only the photic phenomenon, but also the patient’s distance, intermediate and near vision. This does not happen with AcrySof IQ Vivity®, definitely a more forgiving lens in terms of decentration” “The good thing about AcrySof IQ Vivity® is that I do not worry about the lens, because I know it will function well, just like a monofocal, and I am sure I will have nothing to worry about in terms of visual disturbances” Is decentration a real issue? AcrySof IQ Vivity® and Monofocal Angle Alpha Key highlights from surgeons’ clinical sharing in the User Meeting: Dr. Chandrashekar Wavikar, Wavikar Eye Institute, Thane, Maharashtra, India “Patient was so happy with the first eye that she immediately opted for AcrySof IQ Vivity® in the second eye” • AcrySof IQ Vivity®’s forgiving quality makes it eligible for patients with mild retinal diseases • AcrySof IQ Vivity® can also be used in glaucoma patients, with good visual outcomes • AcrySof IQ Vivity® performs well even in eyes with medium-high angle alpha • AcrySof IQ Vivity® visual outcomes are minimally affected by potential lens decentration minimally affected by lens decentration, if it happens AcrySof IQ Vivity® can provide very good far, near, and intermediate visual acuity in complicated cases, such as Glaucoma and mild AMD, according to Dr. Bryan Hung Yuan Lin. He implanted Vivity® in a 70-year old woman with primary angle-closure glaucoma suspect. Preoperative BCVA was 20/63 in both eyes, no damage to the retinal nerve fibre layers was observed and post-op results showed very good vision at all distances. His second case was a 63-year old woman with mild age-related retinal disease: OCT showed mild ERM in the right eye, but an otherwise healthy macula. Pre-op BCVA was 20/63 in the right eye and 20/40 in the left eye. With Vivity®, visual acuity improved significantly. AcrySof IQ Vivity® in patients with AMD and Glaucoma Dr. Bryan Hung Yuan Lin, Zhong-Li Universal Eye Center, Taiwan “With very good far, intermediate and near vision results, all my patients are very satisfied using ArcrySof IQ Vivity® IOLs”
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