Eyeworld

I INNOVATIONS IN LENSES APRIL 2019 | EYEWORLD | 95 they will likely have night vision symptoms, I also describe to them the specific symptoms that they will be having—in the case of the Symfony, fine starbursts with multiple fine halos," he said. He asks about their satisfaction with regard to uncor- rected distance and night vision at 1 day and at 1 week after receiving the IOL in the first eye. "If they are unhappy with either, I will address the issue before working on the contralateral eye. "Before surgery and continuing postop- eratively, it is important to evaluate and treat the ocular surface and macula," he continued. "Postoperatively, uncorrected refractive error and posterior capsular opacification can be sources of unhappiness. I check for these aggressively and emphasize having a good postoperative refraction, being careful not to over-minus EDOF IOL pa- tients. When stable, I offer laser vision correction and/or YAG laser capsulotomy as needed." "Preoperative counseling is key," Dr. Wong agreed. "We advise EDOF patients that they will see a night halo/spider web with 100% certainty and that they will need glasses some of the time for some activities. …We do not promise per- fection and get the patient's buy-in on realistic expectations before they choose to have surgery. Preoperative counseling—medical and psycholog- ical—is mandatory for all patients." For unhappy patients, Dr. Wong offers keratorefractive surgery for refractive misses, lens exchanges, and the full spectrum of refractive surgery. "An unhappy EDOF patient is like any other unhappy refractive cataract surgery patient and should be handled as such—with extra special care," Dr. Yeu said. "Specifically, manage the ocu- lar surface carefully, reserve performing any pos- terior capsulotomy if there is any concern that the IOL would need to be exchanged, address residu- al refractive errors, and see them more frequently than not until the issue can be resolved. I do not move on to the second eye surgery until some resolution is reached with the first eye. Besides greater near vision being achieved with binocular summation, the quality of vision of this IOL is so good that if there is a concern with the IOL itself, Dr. Loden is more cautious. "Although refrac- tive lensectomy works, it comes with trade-offs," he said. "In my opinion there is currently no product that can fully satisfy the patient who has preop BCVA of 20/15 with spectacles or contact lenses. Glare, halos, starbursts, spider webs, loss of contrast, and range of vision all remain issues. Take great care in interviewing your patient and setting expectations preop." Unhappy patients No procedure is perfect, and as in all cases, prepa- ration is everything. "It is exceedingly difficult to handle an unhappy EDOF IOL patient who was not properly counseled preoperatively," Dr. Chang said. "The two primary areas of dissatisfaction with EDOF IOLs are (1) not enough uncorrected near visual acuity and (2) unsatisfactory dyspho- topsias or night vision symptoms." He tells all patients being offered an EDOF IOL, but especially low myopes, that they may still need readers for small print, particularly in dim light. "Additionally, I not only tell them that Symfony IOL in an eye with 12 cut RK Source: Shannon Wong, MD continued on page 96 About the doctors Daniel Chang, MD Cataract and refractive surgeon Empire Eye & Laser Center Bakersfield, California James Loden, MD Founder and president Loden iVision Centers Nashville, Tennessee Shannon Wong, MD CEO of Austin Eye Clinical assistant professor of ophthalmology The University of Texas at Austin Dell Medical School Austin, Texas Elizabeth Yeu, MD Assistant professor of ophthalmology Eastern Virginia Medical School Norfolk, Virginia

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