Eyeworld

R EFRACTIVE 78 | EYEWORLD | APRIL 2022 IMPORTANT PRODUCT INFORMATION ARGOS ® Optical Biometer Caution: Federal (USA) law restricts this device to the sale by or on the order of a physician. Indications: ARGOS ® is a non-invasive, non- contact biometer based on swept-source optical coherence tomography (SS-OCT). The device is intended to acquire ocular measurements as well as perform calculations to determine the appropriate intraocular lens (IOL) power and type for implantation during intraocular lens placement. Intended Use: The Reference Image functionality is intended for use as a preoperative and postoperative image capture tool. It is intended for use by ophthalmologists, physicians, and other eye-care professionals and may only be used under the supervision of a physician. Warnings and Precautions: • Only properly trained personnel with experience may operate the device and control software and interpret the results. • Factors that influence the measurement of patient's eyes are listed in the User Manual (Table 1): pseudophakic eye, wearing contact lenses, fixation problem, cornea opacity, non-intact cornea, refractive surgery, blood in the vitreous humor, retinal detachment, keratoconus, asteroid , ambient light in the room, and deformation of the corneal shape. Please consider the guidance provided in Table 1 when you encounter these factors. • Optical Radiation - This device is equipped with a Class 1 laser light source. ATTENTION: Refer to the ARGOS ® User Manual for a complete description of proper use and maintenance, optical and technical specifications, as well as a complete list of warnings and precautions. © 2019 Alcon Inc. 12/19 US-ARB-1900018 still do a LASIK flap over SMILE rather than do- ing PRK or lifting an old LASIK flap to enhance. Dr. Rebenitsch also mentioned how a dis- cussion on presbyopia plays into patient coun- seling. "From a refractive standpoint, it's im- portant to make patients happy now, but you also have to look at what's best for them in the future," he said. For example, for someone who is +3 and in their early 40s, Dr. Rebenitsch would not choose to do LASIK. Dr. Lee said he never uses a trifocal or multifocal IOL in someone who has had corne- al refractive surgery and he takes that into consideration if a patient has a cataract or has significant presbyopia. "In those situations, I mention that laser- ing the cornea now makes IOL power selection more difficult and may limit IOL options in the future," he said. "If it merits more than just a passing men- tion, that is an indication that refractive lens exchange may be the better surgical option." A patient's age may also play into this discussion. If some- one has a clear lens and is in their 20s or 30s, Dr. Lee said he does not usually address future IOL issues, especially given the availability of the Light Adjust- able Lens (LAL, RxSight). "I am confident that in the future, adjustability will extend to pres- byopia-correcting IOLs as well," he said. However, he noted that he recommends a preoperative monovision trial for laser vision correction candidates who have symptomatic presbyopia and who have not tried it. "If they do not like monovision, they might be better off with refractive lens exchange," he said. "I do not use specific age cutoffs because there is so much variability among pa- tient needs and goals. However, continued from page 76 I am reluctant to do corneal refractive surgery in a hyperope with significant presbyopia and would usually recommend lens exchange." When Dr. Lee performs cataract surgery on someone who had prior refractive surgery, he does not distinguish between LASIK and surface ablation. "I am more concerned about RK versus laser vision correction," he said. "I expect that any corneal refractive surgery I perform will likely cause mild irregularity to the cornea but do not use that to help patients choose their procedure." Dr. Wiley said he thinks that as implant technology gets better, it does guide discussions on refractive surgery. "In the past, when implant technology was in its infancy, the motivation to delay or choose IOL options over corneal refractive options wasn't there," he said. "As IOL technology has advanced, the corneal refractive surgery mindset has changed." For example, he said that he was using cor- neal inlays quite frequently in his practice for a while. KAMRA (AcuFocus) provided distance and near over time, but one issue was that for it to work well, for most patients you had to do LASIK on both eyes and KAMRA on one. Now that trifocals are on the U.S. market, Dr. Wiley noted that the same patient consider- ing LASIK plus KAMRA might be a good can- didate for a trifocal clear lens because it gives distance, intermediate, and near. The expense to the patient for a bilateral trifocal is similar to LASIK and KAMRA, he added, and it tends to be a better and easier approach with more longevity. Dr. Wiley noted that hyperopic LASIK is being done less. A low hyperope or young hyperope tends to be able to accommodate and usually doesn't come in until their 40s. Most hy- peropes who come in are already experiencing distance and near vision loss, he added. Almost all hyperopic patients should be evaluated for lens surgery, as opposed to just corneal refrac- tive surgery, Dr. Wiley said. He cautioned that once you do hyperopic LASIK, it may make the patient no longer a candidate for premium IOL surgery in the future and may limit options. From an age standpoint, Dr. Wiley said, for example, for a 30-year-old hyperope, by the time the patient needs lens surgery, the technol- ogy should have advanced enough where there might be an accommodating lens option. "You

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