JUN 2013

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

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42 June 2013 EW REFRACTIVE SURGERY Presbyopia continued from page 40 Patient history Would physicians' preferred procedure with this patient change if the background was different—the patient had successful or unsuccessful monovision, or wore multifocal contact lenses? Yes, physicians said. "If [the patient was] previously happy with monovision I would, after a conversation, not use a multifocal but would use an aspheric monofocal lens in each eye targeting monovision," Dr. Lawless said. "If not successful previously, I would go with the multifocal option. If [the patient has] never experienced monovision, I would mention it as a possibility in the preop discussion, but would only occasionally choose it these days as a surgical option." However, if that patient had been successful with multifocal con- tacts, Dr. Lawless said he would be even more encouraged to proceed with a multifocal IOL. If the patient had been unsuccessful with multifocal contacts, he would determine the reason preoperatively and would lean toward bilateral +2.5 multifocal ReSTOR implantation or minimonovision in that patient. Dr. Wei said he thinks that the same neuroadapative mechanism in Donn feld nenf d IOL Removal System IOL Removal System monovision could assist in the adaption of a multifocal lens. "In those cases with successful monovision prior to surgery, patients will most likely adapt to multifocal images, and this has been my preferred practice for 10 years," he said. "Those that are not successful, which in my practice is about 10% of candidates, I would not use monovision IOLs or multifocal IOLs, which is contrary to current thinking. Those patients would be more suited to bilateral distance dominant lenses such as the Crystalens [Bausch + Lomb, Rochester, N.Y.] in this instance," Dr. Wei said. In the same way, patients with success using multifocal contact lenses would suggest an adequate ability for adaptation to a multifocal IOL, he said. Dr. Kent said if monovision had not been successful, he would seek answers. Reasons could include unreasonable expectations or poor counseling on both the benefits and drawbacks of monovision. Pearls Preop preparations for this patient are important to outcomes, physicians said. Dr. Kent recommended careful patient selection. "Clearly identify what your patients want and make sure they understand the concepts being discussed and the options that are available and the fact that none of the options available are a panacea," he said. Dr. Lawless recommended careful preop discussion of patient choices. "The conversation prior to surgery is a conversation. After surgery, it's managing a problem, so spend plenty of time preop listening rather than talking, and then make a recommendation with a relative or friend in the room with the patient," he said. Dr. Wei recommended monovision contact lens trials for all patients, to rule out poor candidates. "These are the ones to avoid multifocal lens and the cause of some of the problems traditionally associated with diffractive multifocal lenses," he said. EW K4-5560 Micro IO Cutte cro O utter OL tte r For cutting soft acr ylic and silicone IOLs through a 1.5mm incision r 4mm long, stainless steel blades r Micro notches in the blades help to grasp the IOL during cutting, preventing slippage K5-7570 orce orceps eps    r For securely grasping a soft IOL through a 1mm side por t or during cutting and explantation  r 21 gauge blunt, paddle-shaped tips for strength and safety r Central hole adds traction and visibility Editors' note: Dr. Lawless has financial interests with Alcon. Drs. Kent and Wei have no financial interests related to this article. K10-1014 Contact information Set includes K4-5560, K5-7570 and a free sterilizing tray (K9-2024). fre ree -2 ® Designed with Eric Donnenfeld, MD Rockville Center, NY 973-989-1600 r 800-225-1195 rwww.katena.com Kent: dkent@liverpool.ac.uk Lawless: michael.lawless@visioneyeinstitute.com.au Wei: drmarcwei@yahoo.com.au

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