Eyeworld

I N FOCUS 42 | EYEWORLD | DECEMBER 2019 EXAMINING PRESBYOPIA TREATMENTS PanOptix is available as a toric, correcting up to 3 D of astigmatism (T3–T6 available). Dr. Solomon said he'll pair a nontoric version with femtosecond arcuate incisions for lower amounts of astigmatism, and Dr. Yeu said she'll do the same with a toric version for higher amounts of astigmatism. In terms of setting expectations, Dr. Yeu said she feels looking at patient-specific consid- erations are less of an issue with these lenses. She still sets the expectation that patients will need extra magnification for extremely fine print or in poor lighting conditions, but Dr. Yeu said this conversation is more to cover her bas- es. Dr. Solomon said he also tells patients pre- operatively that a presbyopia-correcting cataract surgery could be a two-part procedure: First to address the cataract and implant the lens and second to perform enhancements that might be necessary. He said enhancements occur in about 15% of premium IOL patients. When to avoid trifocals Dr. Cionni said that although it hasn't been studied, it's likely that patients with significant corneal aberrations would not be happy with multifocal, EDOF, or trifocal IOLs. Patients with RK and keratoconus, for example, would not be good candidates, he said. On a similar vein, corneal abnormalities related to ocular surface disease and dry eye would need to be addressed prior to assessing candidacy for this lens, according to Dr. Solo- mon. If a patient was very concerned about night vision symptoms, Dr. Yeu said she would consider the lowest-add multifocal or an EDOF IOL instead. Starting with a trifocal in the nondominant eye first is key in patients where dysphotopsias were of significant concern. See how they do postop, and treat the dominant eye accordingly. Dr. Donnenfeld said if a patient wanted to have the best possible distance vision, good continued from page 41 Relevant financial interests Cionni: Alcon Donnenfeld: Alcon, Bausch + Lomb, Johnson & Johnson, Carl Zeiss Meditec Solomon: Alcon Yeu: Alcon, Johnson & Johnson Vision, Carl Zeiss Meditec intermediate, and were willing to wear glasses for near, he would still recommend an EDOF lens. However, if their goal is overall spectacle independence at all distances, he said he would offer trifocal technology. Tips for success The doctors noted how forgiving PanOptix seemed to be when slightly off target. Dr. Solo- mon specifically mentioned the defocus curves of the clinical trial data as evidence and com- pared this flexibility to that seen with EDOF technology. "Surgeons still need to be vigilant about getting refractive error as close to plano as they can," he said, noting, however, that airing on the side of slightly hyperopic is yielding good results. Dr. Yeu said she uses 119.1 as her A constant and the Barrett Universal for all axial lengths, comparing calculations with the Hill- RBF. She said she'll start with the nondominant eye, aiming for the first minus of plano to nail both distance and range of near vision. In the dominant eye, she said she'll aim for the closest to plano, even if it's on the hyperopic side. Dr. Solomon said he continues to under promise and over deliver with these lenses. He also emphasized the importance of good preop measurements. He takes at least two biometry measurements using different devices as well as a topography. Overall, Dr. Cionni said he has been involved in many clinical trials for presby- opia-correcting lenses and has "never seen happier patients than I found with the patients I treated in the clinical trial." "We always have to be careful in translating trial results to post-market approval outcomes but, thus far, the patients in whom we've im- planted this IOL since approval are thrilled with their results," he said.

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