14 EyeWorld Asia Pacific | June 2024 SimVis Gekko is a visual simulator that allows the patient to see the real world through any presbyopic correction prior to IOL implantation. Source: 2EyesVision what usefulness it has, but it comes along with the machine because it’s built into it. If someone wanted to simulate the usefulness of IOLs, which is the purpose of the device, they could do this dominance test also.” The group found the majority of people (more than 50%) are strongly dominant (90– 100% preference for one eye), about a quarter have weaker dominance (70–80% preference for one eye), and a quarter have equidominance (50–60% preference for one eye). “This is new breakthrough data that we have no idea what to do with yet,” Dr. Durrie said, noting that the group that gathered the data would soon be discussing its possible implications, which could lead to future studies. Dr. Durrie said that because the SimVis Gekko is easy to use and integrates well into clinic flow—and because of its usefulness to simulate different types of IOLs and vision options—a practice could start gathering real-world data on patients’ sensory dominance and their distance and near preferences. “Record the data on a group of patients, then keep doing what you’re doing with your IOL selection. Retrospectively come back and if you have patients who were having trouble adapting to their lenses, you can say, ‘Let’s look back and see what preference group they were in,’” he said. IOL selection and target setting for mono/blended vision Dr. Durrie said that while there is now an expanded understanding of ocular dominance/ sensory preference, it’s too soon to make any practice changes. “Keep doing what you’re doing and let the research develop,” Dr. Durrie said. “This is new information, and I don’t want it to complicate IOL discussions with patients until more data is gathered.” Dr. Cummings said eye dominance remains critically important for lens and target selection. He said it makes “the difference between success and failure.” Like the findings Dr. Durrie spoke about, Dr. Cummings, and Andrew Kopstein, MD, both said they consider not motor dominance but sensory dominance when helping patients choose a lens and setting their target. “Most think that this is motor dominance, where the finger point or thumb forefinger aperture is determinant. It is not. It relies on ‘sensory dominance,’ which is tested by showing one eye corrected to distance and the other to a myopic target, then compared to the reverse scenario where the fellow eye is corrected to distance and the other to the same myopic target. The combination that feels better is ‘sensory dominance.’ My experience is that motor and sensory dominance correspond 85% of the time,” Dr. Cummings said. CATARACT
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