Eyeworld

NOVEMBER 2019 | EYEWORLD | 19 leagues performed clear cornea kera- totomy incisions in line with the steepest astigmatic meridian for patients with 0.5 to 1.5 D of astigma- tism. The studies do not allow for a com- parison of outcomes in patients with more than minimal astig- matism, which can be managed through limbal relaxing incisions, arcuate keratotomy, or toric IOL designs. Consideration of which presbyopia-correct- ing IOL will depend on lens availability, cost, and the patient's unique needs. As U.S. surgeons now consider the PanOptix and Symfony lenses for their patients, special consideration should be paid to the patient's need and desire for uncorrected near visual acuity. Compared to the Symfony, the PanOptix performs better at closer viewing (all distances 50 cm and below) but is inferior to the Symfony at 1 m viewing. The PanOptix IOL may be better suited for patients preferring a closer intermediate work- ing distance of around 60 cm, such as for some handheld devices and computer work. Notably, the PanOptix is only available in powers +13 D and above, which limits its utility in highly myopic patients when compared to the Symfo- ny. The choice of IOL should continue to be contingent upon individual patient preferences and needs. Discussion As expected, both studies found that the optimal interme- diate performance of the PanOptix and AT LISA IOLs were at their target focal distance at 50–60 and 80 cm respectively. 2 A difference in target distance of 20 cm may make a significant change in comfort level for certain tasks, and thus the choice of IOL may depend on the patient's working distance. Moreover, the study by Böhm echoes previ- ous investigations that have demonstrated that the PanOptix and the Symfony IOLs perform similarly at distance and intermediate distanc- es but that the PanOptix offers superior near visual acuity, 3 a particularly relevant finding for U.S.-based ophthalmologists where both IOLs are now available. Both investigations were prospective in de- sign, but neither was randomized. In the Asena study, patients self-selected the IOL, while the Böhm study did not specify the method of IOL selection. While the lack of randomization may confound the ultimate findings, self-selection of IOL does mimic real world practice in which the IOL is chosen based on the patient's indi- vidual needs and preferences. All IOLs employed were non-toric, with the Asena study excluding patients with corneal astigmatism above 1 D, while Böhm and col- "Consideration of which presbyopia-correcting IOL will depend on lens availability, cost, and the patient's unique needs." —EyeWorld Journal Club

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