Eyeworld

I N FOCUS 50 | EYEWORLD | AUGUST 2019 POST-LVC CATARACT SURGERY to neuroadapt for at least 3 months, he said, but he noted that in the last 4 years, he has placed 1,300 multifocal IOLs and hasn't had to do one exchange. Dr. Walton said it's important to know if refractive error is the only or main issue. If there's anything else going on, it needs to be ad- dressed or carefully explored, he said. The deci- sion to do an exchange depends on the patient. "We tell patients at the beginning: 'The lens we're planning to give you tends to give good distance, good intermediate and even some at arm's length, but it will not give tiny print and dim lighting.' Most people see the broader range as a benefit, but 1% do have us remove it later if they are the minority who don't neuroadapt to the nighttime driving vision," he said. To be a modern refractive cataract practice, being able to do an in-the-bag IOL exchange and have that conversation with patients should be a normal part of what is offered, Dr. Walton added. "It's a basic necessity to offer full refrac- tive cataract surgery, and that wasn't the case 10 years ago." The FDA is requiring RxSight to do another study on eyes that have had previous refractive surgery (such patients were excluded in the first trial). Dr. Walton is part of the LAL clinical trial for previous refractive patients and said they are a good fit clinically and also tend to have an appreciation for technology and what it can bring to their vision. "I think the LAL is going to be a game-changer for the post-LVC patient," Dr. Schallhorn said. "The clinical trial results for this lens are amazing. The ability to offer a near-guarantee of postop refraction is going to be very attractive to that patient population." "These technologies are not only going to make jobs of surgeons easier but will provide visual results that were more difficult to achieve in the past," Dr. Rebenitsch said. Touch-up vs. exchange with presbyopia-correcting IOLs Dr. Rebenitsch said all patients at his practice are counseled that "presbyopic IOLs with current technology are a journey and not an immediate destination." These patients will have continued from page 49 Financial interests Miller: Alcon, Johnson & Johnson Vision, Carl Zeiss Meditec Rebenitsch: Carl Zeiss Meditec, CorneaGen, STAAR Surgical Schallhorn: None Walton: RxSight, Alcon, Carl Zeiss Meditec, Johnson & Johnson Vision Viscoelastic material being removed following implantation of a Light Adjustable Lens Source (all): Kevin M. Miller, MD

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