JUN 2013

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

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February 2011 June 2013 Presbyopia well with a multifocal IOL. With progression of macular degeneration, the benefit of this type of lens could be lost, so it's important to look at the pattern of a patient's macular pathology. Dr. Mackool Sr. said it is usually advised that someone with macular degeneration should not get a multifocal IOL, but there is no definite yes or no answer. However, he said that most people with macular degeneration will not use multifocal IOLs. Especially with mild cases, he would be concerned with putting in a multifocal IOL and then having more severe macular degeneration affect the lens later on. "If there's any drusen at or near the fovea, then I don't do the multifocal IOL," Dr. Berdahl said. In that case, he said an accommodating option or monovision is likely the solution. Diabetes with no BDR or mild BDR with no macular edema Dr. Berdahl said considering someone for a multifocal IOL who has diabetes with no background diabetic retinopathy (BDR) would be no problem. He also said that mild BDR with no macular edema should generally not rule someone out for a EyeWorld factoid Myopia affects about 25% of Americans. Myopia is often diagnosed in children between 8 and 12 years of age and may worsen during the teen years. Little change may occur between ages 20 and 40, but sometimes myopia can worsen with age. Source: The National Eye Institute multifocal IOL. However, the patient would have to show that he or she is trying to control the diabetes. Both Dr. Mackool Sr. and Dr. Mackool Jr. agreed that patients with diabetes and no sign of retinopathy or who have the condition under control could still be candidates for multifocal IOLs. "If they have signs of background diabetic retinopathy, I think that's something that you should consider strongly as a contraindication to doing a lens," Dr. Mackool Jr. said. "Diabetes with no retinopathy is no problem, if the risk of developing sight-threatening retinopathy is low," Dr. Wolfe said. Patients with diabetic retinopathy should be considered on an individual basis. He said presence of macular edema is a bad condition to pair with a multifocal IOL. Mackool Jr. has no financial interests related to the article. Dr. Wolfe has financial interests with Alcon and AcuFocus (Irvine, Calif.). EW FEATURE 33 Contact information Berdahl: johnberdahl@gmail.com Mackool: mackooleye@aol.com Wolfe: rwolfe@vistaeyes.com.au Occu-Flo Punctum Plugs ™ Following up with the multifocal IOL If you're considering implanting these lenses in patients who aren't ideal candidates, they need to indicate that they understand this and the surgeon needs to be comfortable with that fact, Dr. Mackool Sr. said. "The patient should know from the outset that it's not an exact science trying to decide which implant and which implant strength is best for any given patient." He said regardless of the number of measurements and amount of preparation, patients need to know that they may not get a perfect result. "Sometimes people are disappointed if I won't do a multifocal for them," Dr. Berdahl said. He said it's common to see patients with comorbidities when screening for a multifocal IOL. Three critically important keys to consider with multifocal IOLs are patient psychology, patient anatomy, and finishing the job to make sure there is no residual refractive error, he said. Most of his patients have been satisfied with the multifocal IOLs he has implanted because he is conservative in choosing those who receive them. EW Editors' note: Dr. Berdahl has financial interests with Alcon (Fort Worth, Texas) and Bausch + Lomb (Rochester, N.Y.). Dr. Mackool Sr. has no financial interests related to the article. Dr. Occu-Flo™ Plugs Offer: • Easy Insertion • A smooth finish which creates immediate patient comfort • High tolerance by patients • Easy removal if necessary Occu-Flo™ Relieves Dryness and Discomfort Due To: • • • • Post Surgical Complications Seasonal Allergies Medication Side Effects Contact Lens Usage Available Preloaded Sterile on Insertion Handle (2/box) or Nonsterile Bulk USP-3004 .460 1.480 0.660 Large Medium .410 1.330 USP-3006 USP-3005 Small .510 1.580 0.810 1.020 www.usiol.com 2500 Sandersville Rd., Lexington, KY 40511 USA Phone: 859-259-4925, 800-354-7848 Fax: 859-259-4926 E-Mail: usiol@aol.com

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