Eyeworld

81 EW FEATURE October 2018 • Revisiting astigmatism optimized, that would be good. I know Symfony 2 is on the way out at some point, and that is exciting. PanOptix (Alcon) should be a great lens. … Juvene (LensGen, Irvine, California) could change some things. The problems with the light adjustable lenses and the refractive index shaping is that these lenses will be more for missing your target rather than a presbyopia correction technology. Dr. Raviv: The small aperture IC-8 IOL will find utility in complex eyes, such as post-trauma or RK. Its limitations are that it is only indicated monocularly. We are look- ing forward to post-implantation refractive (including astigmatism) adjustment of IOLs, whether with the Light Adjustable Lens (RxSight, Aliso Viejo, California) or refractive index shaping (Perfect Lens, Irvine, California)—though they will be in monofocal versions initially. Dr. Lindstrom: I am excited about IC-8, which will be indicated for corneal irregular astigmatism. EyeWorld: What do you discuss with patients regarding presbyopia- correcting IOLs in the context of their astigmatism and in terms of setting postop expectations? Dr. Patterson: I'm very clear to patients that they can't have it every way. They're not going to have perfect distance, intermediate, and near, and it's not going to be like when they were 20. However, we're going to get their eye seeing the best their eye can see. The only way to do that is to use a lens that can see in multi-ranges with the ability to correct their astigmatism. I think pa- tients respond well to that. If you're not correcting their astigmatism at the same time for patients who will pay for it, you're not helping your patients to the best of your ability. Dr. Raviv: Many patients are sur- prised to hear they have astigma- tism, and I frequently show them their topography and explain that their presbyopia-correcting IOL surgery will include correction of their astigmatism for optimal results. I mention that even with our best diagnostic and surgical technology, residual refractive error (includ- ing astigmatism) may remain, and further enhancement treatment with laser vision correction (PRK or LASIK) can be done. Dr. Lindstrom: I tell them they may need one or two laser enhance- ments (YAG and excimer), there might be night vision symptoms, and they might need occasional readers, and there will be up to a year of neuroadaption to their new vision. This discussion is the same as with a spherical presbyopia-cor- recting IOL. EW Reference 1. Hayashi K, et al. [Changes in corneal astig- matism with aging]. Nippon Ganka Gakkai Zasshi. 1993;97:1193–6 Editors' note: Dr. Lindstrom has financial interests with Alcon, Bausch Health (Laval, Canada), and Carl Zeiss Meditec. Dr. Patterson has finan- cial interests with Johnson & Johnson Vision and Carl Zeiss Meditec. Dr. Raviv has financial interests with Johnson & Johnson Vision. Contact information Lindstrom: rllindstrom@mneye.com Patterson: michaelp@ecotn.com Raviv: tal.raviv.md@gmail.com

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