Eyeworld

I N FOCUS 54 | EYEWORLD | DECEMBER 2019 EXAMINING PRESBYOPIA TREATMENTS Contact information Baartman: brandon.baartman@ vancethompsonvision.com Kugler: lkugler@kuglervision.com Rebenitsch: Dr.Luke@ClearSight.com that are not yet approved in the U.S., specifically PRESBYOND (Carl Zeiss Meditec). "In my mind it's kind of monovision-plus," he said, adding that this option increases the depth of focus through increased spherical aberration. It's typically done in the non-dominant eye, and by doing this, the patient maintains better distance vision and increased near over a more traditional blended vision. If they are accepting of this, and the remainder of exam and testing shows good candidacy for corneal-based refractive surgery, Dr. Baartman provides a contact lens trial for at-home, re- al-life use to ensure this is something they want to commit to. Do you do laser vision monovision for plano presbyopes? Do you do anything different in your process? Plano presbyopes are one of the best challeng- es to the comprehensive refractive surgeon's chairside chat, Dr. Baartman said. "This is one scenario where all options must be openly dis- cussed and very detailed conversations are had about vision correction, including monovision LASIK and refractive lens exchange," he said. "Some of these patients may be disappointed to learn that laser vision correction for enhanced reading vision, in most instances, will be gained at a mild sacrifice to binocular distance vision or depth perception." Depending on lens status, Dr. Baartman said some of these patients are better candi- dates for refractive lens exchange and opt for this. In those that are motivated to give monovi- sion a try, he often uses longer trials of contact lens monovision to ensure this is a suitable option for their visual needs and lifestyles. "I'll often work with the patient's local optometrist to arrange a proper fitting and prescription, so we can identify the perfect monovision correc- tion, and feel confident when we proceed to the laser suite," he said. Dr. Rebenitsch said that his decision would depend on a case-by-case basis. For someone who is younger, we'd opt for blended vision with laser vision correction, he said. But for those age 50 and older, he would recommend refractive lens exchange in one or both eyes, depending on the refractive status and level of dysfunctional lens syndrome. He added that these are "some of our happiest patients," al- though a well neuroadapted person with blend- ed vision can be just as happy, if not happier. Dr. Rebenitsch also added that there are some technologies in other parts of the world continued from page 53 Relevant financial interests Baartman: None Kugler: None Rebenitsch: Carl Zeiss Meditec A sheet used by Dr. Kugler with every patient being evaluated for refractive or cataract surgery. Patients initial by the line corresponding to the level of near vision they expect to achieve after surgery, which helps Dr. Kugler and his practice guide them to the solution that is best able to achieve that, including blended vision for some people, or use the tool to set more realistic expectations, if their desired result is not achievable. Source: Lance Kugler, MD

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