EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
102 February 2011 Cataract/IOLs, femtosecond cataract March 2013 EW FEATURE Managing continued from page 100 crucial if the surgeon detects any intraop stability problems such as pronounced asymmetric posterior vault. The CTR will fully expand the capsular bag and allow the haptics to vault more symmetrically. Also, the CTR can prevent excessive capsular bag contraction particularly in older patients with weaker zonules. "I've had patients with a myopic shift at one month because this lens is inherently more unstable and the haptics will flex as the capsular bag contracts," she said. One pearl in accommodating patients is making sure the haptics stay in the equator. "If they're not in the capsular sulcus, you'll end up with abnormal lens vault, which changes its position," Dr. Berdahl said. Her eye disease. Multifocal IOLs Multifocal IOLs tend to be less forgiving than other IOL types, surgeons said—so it's especially important to correct astigmatism postop or even intraop if possible. Discussing the pros and cons of multifocals in advance of surgery could help head off postop problems that actually are connected to pa- Our motivation. Image is designed to represent nondescript visual impairment and is not intended to be medically accurate. For illustrative purposes only. To learn how Santen is advancing the ophthalmic field, scan this code with your mobile device or visit www.santeninc.com. At Santen, our single focus in ophthalmology enables research of novel therapies in uveitis, glaucoma, and dry eye/corneal disorders—therapies determined to challenge eye disease, one patient at a time. Inspiring ophthalmic medicines © 2012 Santen Pharmaceutical Co., Ltd. All rights reserved. SAN-269.00 07/12 tient expectations. "I tell patients it's not an exact science and that they have to be realistic," Dr. Dhaliwal said. "I tell them that wearing thin glasses for some activities is an acceptable outcome." Optimizing the ocular surface preop in these patients—or really, in any patients having cataract surgery—can help head off postop complications, Dr. Dhaliwal said. If there are problems after surgery, determine if the patient is unhappy with visual acuity (a power mismatch) or visual quality (such as contrast sensitivity issues), Dr. Dhaliwal recommended. "If it's a problem with visual quality despite optimal refraction, an enhancement may not help," she said. If the patient is struggling with nighttime glare and halos, Dr. Dhaliwal suggested driving glasses with any residual refractive error correction (even 0.50 D) or Alphagan (brimonidine, Allergan, Irvine, Calif.) drops at night to minimize pupillary dilation. Sometimes leaving a small light on in the car (such as from the glove compartment) can also help. "I try to stay conservative and avoid refractive surgery in patients who may have potential side effects such as increased dry eye postoperatively," she said. A contact lens trial prior to enhancement can help determine if the patient's symptoms decrease, Dr. Black said. If the patient needs postop corrections, the surgeons interviewed prefer PRK, particularly in older patients who may have more dry eye. However, if the patient requires an enhancement along the lines of 2 to 3 D or higher, Dr. Kim recommended considering the option of an IOL exchange or piggyback IOL. That said, "iLASIK [Abbott Medical Optics, Santa Ana, Calif.] offers a more rapid return of vision as well as less discomfort and is particularly preferred by patients with healthy corneas," Dr. Black said. Because patients with previous refractive surgery require further monitoring for refractive surprises after premium IOL implantation, Dr. Kim is cautious about even considering premium IOLs in this patient group. "If it's a high myope, you've already altered the normal profile of the cornea and induced aberrations. By implanting a multifocal IOL in these patients during cataract surgery, you run the high risk of further decreasing contrast sensitivity and exacerbating the higher-order abercontinued on page 106