Eyeworld

98 | EYEWORLD | JULY 2021 R EFRACTIVE When considering the ICL, Dr. Trattler said that a key criteria is that the eye has a certain size anterior chamber depth. If you have an eye that has a shallow anterior cham- ber, there will not be sufficient space for the ICL. Allison Jarstad, DO, offers LASIK, PRK, and refractive lens exchange to her patients. "When creating a treatment plan, I have a holistic approach and take the patient's age, the stability of their refraction, and the entire eye into consideration. A laser procedure is usually the better option for younger eyes that are refractively stable," she said. She prefers laser refractive procedures as long as the corneal topography shows no evidence of keratoconus or FFK. "I like to leave an RSB of 300 µm to be safe, but I am pretty conservative," she said. "If there's anything suspicious on topography and if the pa- tient is young (early 20s), I will monitor for 6 months to a year prior to proceeding with laser vision correction. If the patient is older (40s or 50s), I counsel them on the much lower but possible risk of post-refractive ectasia." Dr. Jarstad prefers PRK over LASIK for patients with glaucoma in order to avoid an IOP elevation when creating the LASIK flap. She opts for PRK in patients with ABMD since they often benefit from a superficial keratectomy. For patients outside of the range of laser refractive correction and who want to avoid intraocular surgery, treat- ing a majority of their refractive error can still yield good results. She sometimes offers PRK on top of a fully healed PKP graft in a young person who doesn't have evidence of a cataract but has postoperative myopia or astigmatism. If there is topographic evidence of mild keratoconus or FFK, Dr. Jarstad recommends a phakic IOL. However, she cautioned that you need to ensure that the patient receiving a phakic IOL has a deep enough anterior cham- ber, which usually is the case in highly myopic patients. She also mentioned the importance of obtaining a specular microscopy to ensure a healthy endothelial cell count. For iris-claw phakic IOLs you want to make sure the iris tissue is without atrophy or any abnormalities, Dr. Jarstad added. Though she does not implant phakic IOLs, Dr. Jarstad said she has removed them at the time of cataract surgery for many patients. "I think they are a great option in young- er patients who are extremely myopic and are unable to undergo LASIK," she said. "If their pachymetry is too thin for LASIK or PRK or if their treatment is outside the param- eters of our laser, I will discuss a phakic IOL and refer these patients to a colleague who implants them." For patients over age 50 who have no evidence of cat- aract and would like to have refractive surgery, Dr. Jarstad will consider LASIK with monovision, but she also counsels them on refractive lens exchange with either monovision or a multifocal or EDOF IOL. When considering LASIK vs. lens replacement, Dr. Jarstad said it's important to look for narrow angles as this continued from page 96 AcrySof ® IQ PanOptix ® Family of Trifocal IOLs Important Product Information CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof ® IQ PanOptix ® Trifocal IOLs include AcrySof ® IQ PanOptix ® and AcrySof ® IQ PanOptix ® Toric IOLs and are indicated for primary implantation in the capsular bag in the posterior chamber of the eye for the visual correction of aphakia in adult patients, with less than 1 diopter of pre-existing corneal astigmatism, in whom a cataractous lens has been removed. The lens mitigates the effects of presbyopia by providing improved intermediate and near visual acuity, while maintaining comparable distance visual acuity with a reduced need for eyeglasses, compared to a monofocal IOL. In addition, the AcrySof ® IQ PanOptix ® Toric Trifocal IOL is indicated for the reduction of residual refractive astigmatism. WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia and ensure that IOL centration is achieved. For the AcrySof ® IQ PanOptix ® Toric Trifocal IOL, the lens should not be implanted if the posterior capsule is ruptured, if the zonules are damaged or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction. If necessary, lens repositioning should occur as early as possible prior to lens encapsulation. Some visual effects may be expected due to the superposition of focused and unfocused multiple images. These may include some perceptions of halos or starbursts, as well as other visual symptoms. As with other multifocal IOLs, there is a possibility that visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. A reduction in contrast sensitivity as compared to a monofocal IOL may be experienced by some patients and may be more prevalent in low lighting conditions. Therefore, patients implanted with multifocal IOLs should exercise caution when driving at night or in poor visibility conditions. Patients should be advised that unexpected outcomes could lead to continued spectacle dependence or the need for secondary surgical intervention (e.g., intraocular lens replacement or repositioning). As with other multifocal IOLs, patients may need glasses when reading small print or looking at small objects. Posterior capsule opacification (PCO) may significantly affect the vision of patients with multifocal IOLs sooner in its progression than patients with monofocal IOLs. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure, available from Alcon, informing them of possible risks and benefits associated with the AcrySof ® IQ PanOptix ® Trifocal IOLs. ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions. © 2019 Alcon Inc. 8/19 US-ACP-1900043

• Blank Page
• Blank Page (1)