Eyeworld

SEPTEMBER 2021 | EYEWORLD | 63 R Contact Donnenfeld: ericdonnenfeld@gmail.com Williamson: blakewilliamson@weceye.com Yeu: eyeulin@gmail.com patient dissatisfaction. After these, he said he would start with trifocals because they give true spectacle independence. While these are high-reward lenses, he said surgeons need to pick ideal candidates. The low-hanging fruit when you're starting in this space, Dr. Donnenfeld said, are hyperopic patients with a significant cataract. Dr. Williamson offered the same point about selecting a hyperopic patient for earlier cases with presbyopia-correcting IOLs. "That's a person you'll make happy no mat- ter what you do," Dr. Williamson said. His other advice is to understand that different optics and different materials perform differently, and the patient education and in- formed consent need to be tailored as such. "The most important thing you can do as a young surgeon is master the preop consult and preop expectation setting," Dr. Williamson said. He also said to tell patients they will experi- ence glare and halos with these lenses; make it very clear what the side effects will be and that they might experience them for a few months. "… pick the right patient and let them know ahead of time what the shortcomings of the lens may be; if you do that, you're going to save yourself from 99% of pitfalls postoperative- ly," Dr. Williamson said. With more and more presbyopia-correcting IOLs coming to the market, will they increase the market share? Dr. Williamson thinks so to some extent, but he doesn't think these tech- nologies will earn a significant portion of the market overall. Why? First is cost; Dr. William- son said some patients can't afford premium lenses or don't want to pay out of pocket for their IOLs. The second reason is meeting ex- pectations; some physicians, he said, are not comfortable with setting these expectations and/or needing to meet them for patients who are choosing to pay out of pocket. "As the lenses get better and as we get better at selecting the right patients and the right diagnostics, I think you'll see adoption go up," he said, adding that younger generations of ophthalmologists coming into practice could be a force to increase adoption of presbyopia-cor- recting IOLs. the dsyphotopsias that you see with a multifo- cal lens. … The contrast sensitivity with and without glare is the same as a monofocal lens," he said. As a biomimetic lens, Dr. Donnenfeld said it fills the capsular bag. Going out to 5 years, capsules of eyes that have received this lens are completely clear (without opacification), and Dr. Donnenfeld said there is minimal risk for posterior vitreous detachment or floaters. "Presbyopic, accommodating lenses are the future. We're going through a period of time now where we've seen dramatic improvements with multifocal lenses, but in the future, I think that accommodating lenses will replace our traditional multifocals, and the technology will continue to improve," he said. Advice for young eye surgeons Drs. Yeu, Williamson, and Donnenfeld offered their advice to young eye surgeons on when new lens technologies become available. Dr. Yeu said surgeons should be comfortable with management of dissatisfied patients. "We have to have things in place so we can help manage those patients in the instance that we're not able to meet their expectations," she said. "If [a young eye surgeon is] comfortable with that, I would say talk to someone you trust in terms of technologies, especially with early adopters." For surgeons who have some trepidation about newer technologies, Dr. Yeu said to look at lenses that have been out for longer vs. what's brand new. These lenses, she explained, go through their own learning curve once they enter the market, with surgeons learning over time how they perform in the real world in terms of quality of vision, patient satisfaction, and side effects. The longer track record, she said, is what can give surgeons confidence with PanOptix. "There are several years of good data out there, and it performs well. If a [young eye surgeon] wanted to jump into multifocality, it's a great time to jump into multifocal IOLs," Dr. Yeu said. Dr. Donnenfeld said getting into toric IOLs first is a great way to enter the premium IOL space. Then he said to consider low-add EDOF lenses, describing them as having less risk of

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