Eyeworld

94 EW MEETING REPORTER because it's not uncommon for the haptic to rotate and pop into the area of weakness. For this patient, Dr. Chang ulti- mately chose a toric lens. Editors' note: The speakers have finan- cial interests with a number of ophthal- mic companies. Achieving high patient satisfaction with presbyopic IOLs Kendall Donaldson, MD, Planta- tion, Florida, presented on mono- vision as an alternative to presby- opia-correcting IOLs. She first shared some "facts and fallacies about monovision." Two myths are that (1) monovision is no longer fashion- able, and (2) more expensive presby- opia-correcting IOLs have replaced monovision. Two facts, she said, are that (1) monovision predates multi- focal and accommodating IOLs, and (2) monovision still survives and is the most common form of presby- opia correction. When choosing a near target, Dr. Donaldson suggested targeting more anisometropia in patients with prior monovision (–1.5 to –2 D) and targeting mini-monovision in those new to monovision (–1.25 to –1.5 D). When and why is monovision the best option? Certainly, there's Pepose, MD, PhD, Chesterfield, Mis- souri, Audrey Talley Rostov, MD, Seattle, and John Hovanesian, MD, Laguna Hills, California. Dr. Chang presented a case of a cataract patient who was a com- puter engineer, a myope, and hated glasses. Dr. Chang asked the audi- ence what they would recommend for the patient who dislikes glasses, and 30% indicated that they would generally choose monofocal mono- vision. Additionally, 18% chose a diffractive multifocal IOL and 24% chose a diffractive EDOF IOL, while 20% said they would combine these two options. Dr. Solomon said he might first test the patient with contact lenses for monovision to see if he could tolerate it. Dr. Chang asked the audience the same question again after presenting more details on his specific patient, indicating that the patient was very visually demand- ing and described himself as nearly a perfectionist. Audience members still largely (39%) chose monofocal monovision, and 41% said they would now refer this patient. Dr. Hovanesian said he might try a low-add multifocal and added that he has had great success with the Crystalens (Bausch + Lomb, Bridgewater, New Jersey) in patients like this. The Crystalens was ulti- mately what Dr. Chang chose. In addition to being visually demanding, complications that came up with this patient were postop refractive shift and Z syn- drome. Dr. Chang asked audience members how they would manage Z syndrome, and 40% indicated they would YAG the posterior capsule. Dr. Hovanesian said that since the posterior capsule is still intact, that's something to address. He said he would not choose to do an IOL exchange. The issue isn't with clarity as with range of vision, which can be adjusted with an excimer laser. However, he noted that this would be the second procedure, and he would first do a YAG. Dr. Chang also cautioned that if you YAG and it doesn't work, you cut out the idea for an IOL exchange. The second panel of the session con- sisted of Thomas Samuelson, MD, Minneapolis, Richard Lindstrom, MD, Minneapolis, Randall Olson, MD, Salt Lake City, Kevin Miller, MD, Los Angeles, and William Trattler, MD, Miami. One case they commented on was a white lens in a 16-year-old uveitis patient. Dr. Chang asked what IOL mate- rial would be best in a young uveitis patient. Audience members over- whelmingly (70%) chose hydropho- bic acrylic, and Dr. Olson added that this is recognized to be the safest option. During Dr. Chang's case, an anterior chamber tear occurred, which he noted was likely because he overfilled one side and pushed the cortex to one half of the capsular bag, causing it to split. To handle an anterior chamber tear, half of the audience indicated they would attempt to rescue one side, while about a third (34%) said they would convert to can opener. Attendees were also asked which lens they would implant in this scenario. Thirty-nine percent chose a single piece acrylic toric in the bag. Dr. Trattler agreed a toric IOL could be an option for this patient, and Dr. Samuelson said that he would choose a toric if the haptic orienta- tion was in an optimal position. Dr. Olson said he might be leery of a toric under these circumstances EyeWorld/ASCRS reports from the 2019 Hawaiian Eye Meeting, January 19–25, Big Island of Hawaii March 2019 View videos from the 2019 Hawaiian Eye: EWrePlay.org Elizabeth Yeu, MD, discusses the prophylactic management of herpetic eye disease in preparing for cataract/refractive surgery.

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