Eyeworld

DEC 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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12 EW NEWS & OPINION December 2012 Success continued from page 11 phone, to the look and feel of the office, and the amenities and services available to patients. But it���s not just about the surface appearance or creating a ���sales��� environment. In fact, we are careful never to surprise the patient with a sudden uncomfortable choice or hard-sell tactics. Rather, we approach lens selection from the perspective of meeting patient goals. We ask patients what they like and don���t like about their vision, and what they want to be able to do without glasses after surgery. Then, we determine if there is a technology (or combination of technologies) that will help them achieve those goals. This means that you really need to understand both the patient and the science behind each of the IOLs. I implant five different premium IOLs, with the Tecnis Multifocal (Abbott Medical Optics, Santa Ana, Calif.), AcrySof IQ Toric (Alcon, Fort Worth, Texas), and STAAR Toric (STAAR Surgical, Monrovia, Calif.) being the most common, and the AcrySof ReSTOR (Alcon) and the Crystalens (Bausch + Lomb, Rochester, N.Y.) being less common. Defocus curves can tell you a great deal about how the lenses work. A multifocal lens will have two peaks, with a range in between where vision is not as sharp. The ReSTOR +4 D lens has a large ���doughnut hole��� in the middle of its near and distance peaks, with poor intermediate vision; the Tecnis Multifocal +4 D lens has a smoother range of vision; and the ReSTOR +3 D lens has two peaks that are closer together, but with less effective near vision. These are real differences��� and choosing the best ���fit��� for the patient is key to satisfying expectations. I typically choose a Tecnis Multifocal for the patient who wants to be able to do near tasks in all light levels without glasses. I���ve been impressed by the quality of the night vision with this lens, the clarity of the distance, and fewer subjective complaints. For some patients for whom intermediate vision trumps near, I may consider a ReSTOR lens, and for postrefractive patients, I will opt for the Crystalens. I recently saw a patient who had premium IOL surgery elsewhere. In the absence of guidance from the surgeon, she chose based on price alone and hated the result. The lens she got was a good lens���it just wasn���t appropriate for her goals. It is our role as surgeons to make an educated choice of which technology best suits the patient���s needs. We do patients a disservice if we give them lens options without direction or eliminate options that would best serve them. EW References 1. Schmoll C, Tendo C, Aspinall P, Dhillon B. Reaction time as a measure of enhanced blue-light mediated cognitive function following cataract surgery. Br J Ophthalmol 2011;95(12):1656-9. 2. Asplund R, Ejdervik Lindblad B. The development of sleep in persons undergoing cataract surgery. Arch Gerontol Geriatr 2002;35:179���87. 3. Asplund R, Lindblad BE. Sleep and sleepiness 1 and 9 months after cataract surgery. Arch Gerontol Geriatr 2004;38:69-75. Editors��� note: Dr. Bosem is medical director, CorrectVision Laser Institute, with locations in Pembroke Pines and Weston, Fla. Dr. Bosem has no financial interests related to this article. Contact information Bosem: 954-437-9300, info@correctvision.com

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