MAY 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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14 Supplement to EyeWorld May 2013 Achieving success with multifocal IOLs by Elizabeth A. Davis, MD, FACS Elizabeth A. Davis, MD, FACS " The first step toward success with multifocal IOLs is careful patient screening. " Careful patient counseling and screening are two keys to patient satisfaction I have had a very high patient satisfaction rate with multifocal IOLs, and the keys to optimal patient satisfaction are patient screening, meticulous surgery, and patient counseling. In addition to screening patients from an anatomy and disease standpoint, I also consider patients' needs, desires, and personality. Patients are counseled about nighttime glare and halos, which are inherent with these lenses due to their design. Patient screening The first step toward success with multifocal IOLs is careful patient screening. If a patient has macular degeneration, diabetic retinopathy, or severe pseudoexfoliation with phacodonesis, I may decide not to even offer multifocals as an option because the risk of a poor outcome may be high. Additionally, patients who have no desire to reduce their need for glasses or contact lenses would obviously not be interested in this technology. I also rule out any patient who appears to be a perfectionist and any patient who indicates that he or she is sensitive to glare and halos at night. I also typically don't consider multifocal IOLs in patients who have previously undergone corneal refractive surgery due to the risk of poor quality of vision. Most patients are good candidates for multifocal IOLs. If I have not ruled patients out during this initial screening, I then pay careful attention to their ocular surface, both from the lipid layer and aqueous layer point of view. I examine the lids and lashes carefully for meibomian gland disease. If I have any suspicion about any macular abnormalities, I perform a macular OCT. I also examine the optic nerve to make sure the patient doesn't have pre-existing optic nerve disease. Figure 1 Figure 2 Maximizing the ocular surface allows us to get good keratometry and corneal topography measurements. All patients undergo corneal topography to determine how much corneal astigmatism they have. Patients with more than 0.75 D of corneal astigmatism who choose multifocal IOLs will likely require Source: Elizabeth Davis, MD laser vision enhancement postoperatively because toric multifocal IOLs are not yet available in the United States. We also will get a pachymetry measurement. Pachymetry combined with topography determines whether a laser vision enhancement can be performed.

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