Eyeworld

I Contact information Name: by Title NOVEMBER 2019 | EYEWORLD | 41 Our Charity Delivers High-Volume, Well-Equipped Phacoemulsification Projects to the Impoverished of Mexico. We are Now Recruiting Volunteer Phaco Surgeons for Our Upcoming Surgical Projects in 2020. Learn More About Us and Contact Us at: www.choseneyemission.com Are You a Phaco Surgeon Interested in Compassionate Surgery in the Developing World? Dr. Aldave said he personally does not use toric lenses for patients with keratoconus but noted that these lenses may be used in the setting of topographic stability, or- thogonal astigmatism, and in patients who are not rigid gas permeable or scleral lens wearers. Dr. Aldave does not recommend the use of multifocal IOLs for keratoconus patients. Dr. Beckman agreed that he's "not a big fan" of a multifocal lens in these patients. Potential problems are the obvious aberrations from the cornea, the cornea may be changing, and you also may be "way off in power just by virtue of the inaccuracy of their measurements preop- eratively." For this reason, Dr. Beckman said this choice would be a riskier option, but some doctors may choose this option if the astigmatism is mild. Dr. Beckman said that a toric lens is an option that he has used in patients with keratoconus. "But you want to make sure they're fairly regular and fairly stable," he said. "A lot of these patients have a lot of astigmatism, and you may not be able to fully correct the astigmatism with a toric." He added that the patient may appreciate the option of debulking the astigmatism with a toric and then wearing weak glasses or contacts. "The concern is if you put a toric lens on these pa- tients, they may then may not be able to wear a gas perme- able or scleral lens," Dr. Beckman said, adding that those lenses correct all of the corneal astigmatism (but some of that has been corrected inside of the eye) so you might get an overcorrection with the contact lens. For patients with keratoconus, a multifocal will not be effective, Dr. Trattler said. "They already have a multifocal cornea, so you want to avoid a multifocal or EDOF lens." If the astigmatism is irregular, astigmatism-correcting IOLs are often not the best option for patients with ker- atoconus, Dr. Trattler continued. Toric IOLs can be used if the astigmatism is regular but not if there's a significant skew in the axis. If the axis is skewed, there is no clear axis to orient the toric IOL, he said. Dr. Trattler said that you also have to consider if the patient wears a scleral lens, RGP lens, or hybrid lens and plans to continue to wear one after cataract surgery, then a toric intraocular lens is not the best plan of action. A monofocal lens will be the better option, but Dr. Trat- tler said to choose one without negative asphericity. A steep cornea means that the cornea already has significant negative asphericity, he said, and there is no need to use a monofocal IOL that provides additional negative aspherici- ty. Instead, consider a monofocal IOL with neutral asphe- ricity.

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