Eyeworld

EW CATARACT 33 October 2018 Learning curve According to Dr. Garg, placing a lens in the sulcus is not common- ly performed. "I encourage our residents to practice placing three- piece lenses in intact capsular bags because placing a three-piece lens into the bag requires a little more nuance and sort of gymnastics with the haptics and how the lens acts in the eye compared with a one-piece lens. A one-piece lens is usually for- giving and goes into the eye easily. With a three-piece lens, depending on the model that you're using, you have to twist and turn as you go in to make sure that it comes out in the right orientation. I would rec- ommend practicing on eyes when things have gone well," he said. Dr. Garg also recommended practicing with different three-piece lenses. "With some lenses, there can be a little bit more pressure getting through the wound. In an eye with a capsular tear, putting pressure on the wound can sometimes promote vitreous coming forward. I recom- mend enlarging the wound a little bit so that when you go into the eye, you're not causing any undue pressure," he said. Dr. Greenwood agreed, noting that it requires a different skill set to put a lens in the sulcus. "You don't want it to be your first time or your staff's first time using a three-piece IOL when it's in the heat of the moment and you're a little nervous because you had a complicated cat- aract, it's taking a little longer, and the patient is a little less comfort- able. Make sure that you and your staff are comfortable loading and injecting three-piece IOLs," he said. Dr. Yeu added that new sulcus- based technologies are needed. "It would be helpful to use sulcus-based technologies to create zero accom- modation or a pinhole effect to improve presbyopia correction in someone who is already pseudopha- kic. There are options that we have not explored with current technol- ogies, but it is a procedure that we generally reserve for when we are either fixing a refractive miss or be- cause there's a capsular bag compro- mise. But I do think the sulcus space holds potential for ways that we can help patients in the future once we have technologies that are compatible with living in the sulcus space," she said. EW Editors' note: Dr. Garg has financial interests with Johnson & Johnson Vision and Carl Zeiss Meditec. Dr. Yeu has financial interests with Johnson & Johnson Vision. Dr. Greenwood has no financial interests related to this article. Contact information Garg: gargs@uci.edu Greenwood: Michael.greenwood@ vancethompsonvision.com Yeu: eyeu@vec2020.com Where no challenge is too great. 840 Walnut St., Philadelphia, PA 19107 | willseye.org | 877.289.4557 Carol L. Shields, MD Director, Ocular Oncology *Based on a Doximity clinical reputation survey for 2018-2019. When conquering eye disease demands resolve, we embrace the long and difficult road. That's part of the reason so many residents want to come to Wills Eye Hospital to train. We teach perseverance. Voted #1 ophthalmology residency program in the United States.*

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