29 EyeWorld Asia-Pacific | September 2024 Tips For IOL Exchange We are living in an age where we can deliver some of the most precise refractive results to patients to help meet their expectations and lifestyle needs. Yet the one thing we cannot do is predict with absolute certainty which patients will not be completely satisfied with their results or adapt flawlessly to new lens technologies. As a cataract surgeon, it is important to be comfortable managing patients in these situations. In this issue’s YES Connect column, we explore the ins and outs of IOL exchange. The initial steps a surgeon takes in diagnosis and communication can set them up for success. Allison Chen, MD, and Yvonne Wang, MD, are both cornea and refractive specialists who perform IOL exchanges for a multitude of reasons. Here they discuss some vital tips for every cataract surgeon to be familiar with. IOL exchanges can be a very rewarding experience, both for the surgeon and the patient. I’m excited to share the expert advice of these two phenomenal surgeons with the YES community as we strive to meet the needs of our patients. —Masih Ahmed, MD, YES Connect Editor When it comes to doing an IOL exchange, there are a variety of factors involved in why the patient may be unhappy and how to proceed. Yvonne Wang, MD, and Allison Chen, MD, discussed scenarios where an IOL exchange may be necessary and techniques to perform it. Common scenarios Dr. Chen said that the most common reasons patients are referred to her for an IOL exchange are poor quality vision with multifocal or EDOF IOLs, UGH syndrome, persistent positive or negative dysphotopsias, or unexpected refractive outcomes. Positive dysphotopsias usually occur due to diffractive optics, and poor quality of vision can occur with diffractive optics or non-diffractive EDOF IOLs. Dr. Wang said she is also most commonly referred with patients for IOL exchanges, who are unhappy with a multifocal lens due to the dysphotopsias. The patients end up seeing much more glare or do not receive their desired quality of vision, so you could exchange that lens for a monofocal lens. She has also encountered a few scenarios where it was necessary to exchange a monofocal to a different type of monofocal because of dysphotopsias. This typically requires switching to a lens with a lower index of refraction. “It is important to discuss the risk of glare and halos when obtaining consent from patients for multifocal IOLs,” she said. by Ellen Stodola, Editorial Co-Director REFRACTIVE SURGERY
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