Eyeworld

86 | EYEWORLD | JULY 2021 ATARACT C Contact Farid: mfarid@hs.uci.edu Scott: mariacscott@yahoo.com Relevant disclosures Farid: Bausch + Lomb, Carl Zeiss Meditec, Johnson & Johnson Vision Scott: Carl Zeiss Meditec, Johnson & Johnson Vision macular scarring, dense floaters, high chord mu, and high corneal aberrations are all conditions that would make her hesitant to offer a presby- opia-correcting lens to a patient. When determining if it's appropriate to pro- ceed with lens implantation in these cases, Dr. Scott said it depends on the severity of the con- dition and the age of the patient. For example, she said that if a patient has very mild drusen but is 85 years old and wants a presbyopia-cor- recting lens, she would consider implanting one. However, if the patient is 45 years old, she likely would not consider it. A mild glaucoma suspect patient could do well with a presbyopia-correct- ing lens, she said. But she generally avoids these lenses with EBMD and epiretinal membranes be- cause they are unpredictable. "Since pseudoex- foliation is progressive, I avoid presbyopia-cor- recting lenses in these patients," she added. Dr. Scott said in patients who are not good candidates for presbyopia-correcting lenses, she will discuss monovision or mini- monovision. This slightly under corrects the non-dominant eye to give patients the ability to see the dashboard and eat their food with- out glasses, she said, adding that the Eyhance (Johnson & Johnson Vision) may be a good option for those patients. Dr. Scott said she is a big proponent of multifocal lenses. "I have enjoyed watching my mother function without glasses after her presbyopia-correcting lenses. She had cataract surgery in 2006 and has enjoyed 15 years of great near and distance vision. At 90, she drives to and from Philadelphia and Annapolis like she is going to the grocery store and reads the recipes to me when we cook together," Dr. Scott said. "Now that I am presbyopic, I understand the frustration that patients feel. I look forward to the choices of presbyopia-correcting lenses growing and improving so that we as surgeons can give our patients the most freedom from glasses without the side effects of starbursts and halos. As a surgeon, you must believe in the technology, be excited about it, and be willing to take the extra steps to hit the target and enhance the patients who need further treatments." Talking to patients prior to surgery Dr. Scott said she educates patients on their options and finds out what their hobbies, night- time driving demands, and work demands are. "I try to tailor the lens discussion to what they enjoy and what would work best for them," she said. Dr. Scott also warns multifocal patients about halos and starbursts and explains that most patients have them initially, and 95% resolve. While 5% persist, 95% of those pa- tients still like the lens so much that they gladly put up with the halos for the convenience of no glasses, she said. A lens exchange may be needed in the less than 1% of patients who can't neuro-adapt. "Also, less than 1% of the time, the support is not sufficient to use the multifocal," she said. "I always ask if the patient would rath- er distance or near vision if we can't implant the multifocal." Dr. Farid said one of the key points she makes to patients is that "every eye is different, and every patient is different." Everyone comes in wanting what their friend has, but it's import- ant to explain to the patient that an individual's ocular health determines the best lens choice. "I want to make sure the patient understands that we're customizing the lens choice to their specific situation and their ophthalmic tests," she said. Dr. Farid said she's an advocate of showing patients images of their tests, pointing out any irregularities or reasons why she might not be selecting a presbyopia-correcting lens for them. This approach has come from experience, and it's important that patients aren't left wondering why they weren't offered a specific lens. "Lens technologies are fantastic, and we have lenses for all types of eyes," she said, noting that she will usually make one or two lens recommenda- tions to patients based on the data for their eye. "We're looking forward to continued innovations in intraocular lens technology to improve contrast and quality of vision to such an extent that even patients with imperfect eyes can be candidates for depth of focus and improved range of vision," Dr. Farid said. continued from page 84

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