16 EyeWorld Asia Pacific | June 2024 ASIA-PACIFIC PERSPECTIVES Ocular dominance is not considered much when planning bilateral implantations of the same diffractive trifocal IOLs. However, when mono/blended vision is planned with monofocal or EDOF IOLs, ocular dominance becomes a common starting point of pre-operative planning. Usually, emmetropia is targeted in the dominant eye, while a certain degree of myopia is targeted in the non-dominant eye. It is not unexpected that there is variance in the level of ocular dominance. There are few devices that can quantitatively measure ocular dominance. The concept of patients having different distance/near preferences to their ocular dominance is also intriguing. Diagnostic devices which can evaluate ocular dominance in various aspects will be useful for patient conversations in lens selection. Vision is a complex sensation, with the vision system including two eyes and the brain. The optics of an eye are responsible for forming a sharp image on the retina, with each eye having different optics. Certain optical Shiney Seo, MD RANZCO 501 Stanley Street, South Brisbane, Queensland, Australia shineyseo@gmail.com Myoung Joon Kim, MD Renew Seoul Eye Center 528 Teheran-ro, Gangnam-gu, Seoul, Korea mjmjkim@gmail.com features can enhance intermediate/near vision. Such optical properties of an eye are changed enormously by a cataract operation. The neural processing of vision which occurs in the brain is not yet well understood, including how it interacts with the optics of the eye. Ocular dominance is the outcome of long-term combination of the eye’s optics and the neural system, which cannot be a simple process. Currently, we are using overly simplified methods such as a finger triangle test to assess ocular dominance. Such methods are seemingly in their infant stages of clinical relevance; a systematic and quantified assessment of ocular dominance could open the doors to numerous research and clinical questions. Depending on the findings, this could potentially become an integral part of the future pre-operative patient assessment and consultation process. Editors’ note: Dr. Shiney Seo and Dr. Myoung Joon Kim disclosed no relevant financial interests. About the Physicians Arthur Cummings, MD | Medical Director, Wellington Eye Clinic, Dublin, Ireland | abc@wellingtoneyeclinic.com Daniel Durrie, MD | Chairman, iOR Partners, Overland Park, Kansas | ddurrie@iorpartners.com Andrew Kopstein, MD | K2 Vision, Seattle, Washington, Scottsdale, Arizona | akopstein@myk2vision.com This article originally appeared in the March 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Relevant Disclosures Cummings: Alcon Durrie: 2EyeVision Kopstein: None tolerate the blurring on my right eye more than I will on my non-dominant left eye. About 20% of patients are like this, so it’s important to do dominance testing but also to verify that the dominant eye is indeed the distance preferred eye,” he said. “If you end up adjusting the LAL in the nondominant eye for reading and that’s actually the eye that the patient prefers for distance, you will likely have an unhappy patient.” Dr. Kopstein said the conversation with LAL patients about its EDOF qualities after the light delivery device adjustment calls into question for some patients why you wouldn’t just use monofocal lenses to achieve monovision/blended vision effects. “We have been gathering data to answer the question: What are the distance characteristics of the nearpreferred eye after bilateral LAL lock-in?” he said. “The range of refraction for the near preferred eye with the LAL is plano to –1.75 in our first thousand bilateral ‘lockins’ (average –0.75). For these near-preferred eyes, the distance vision range is 20/20 to 20/80 (median 20/30). This is very different from ‘standard IOL’ monovision, where the patient closing their distance eye rarely has useful distance vision in the near-preferred eye. This appears to be a unique feature of the LAL compared to the standard monofocal IOL.” CATARACT
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