EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/146899
40 February 2011 Cataract challenges July 2013 EW FEATURE The challenges continued from page 38 this shotgun approach, he said. The cost, corneal toxicity, and ocular discomfort of NSAID use are additional negatives. Instead, Dr. Miller prefers to use NSAIDs if he is addressing eyes that are at a high risk for macular edema. These may include patients with pre-existing retinal vascular pathology, patients with diabetes, vein occlusion, or retinitis pigmentosa. He said in these cases, he would have a patient use NSAIDs both preoperatively and postopera- tively. "Generally, I will start the NSAID about a week before surgery, three to four times a day." Dr. Miller has patients use an NSAID for three to four weeks after surgery, making a reassessment around four weeks. Multifocal IOLs for retina patients Dr. Choudhry said he does not implant multifocal lenses in patients who have macular disease. "How- ever, if patients have a normal macula and have had a peripheral retinal tear or something of that nature, it often doesn't conflict with them having a multifocal lens." A macular disease often means that a patient's vision is compromised, Dr. Choudhry said, therefore this would mean he or she is not a good candidate for a multifocal IOL. Dr. Rosenthal said a multifocal lens for a patient with advanced macular disease may not be a good Donn feld nenf d IOL Removal System IOL Removal System Surgery and laser treatments through multifocal IOLs One other concern with multifocal IOLs and macular disease is the possibility of having to do more surgeries at a later time if the macular condition worsens. Dr. Rosenthal said that he does not think operating through a multifocal IOL is a huge obstacle. A multifocal lens does not usually inhibit future operations or laser procedures, although it was originally thought that this would cause a problem. "The consensus of my retinal colleagues is that the multifocal lens does not generally present a significant impediment to doing detailed retinal surgery given modern retinal equipment," Dr. Rosenthal said. Dr. Miller said operating through a multifocal IOL is doable, but retina specialists would probably prefer a clean view. "I think retina specialists generally don't like multifocals because it does mess up their view of the posterior segment." EW K4-5560 Micro IO Cutter cro OL Cutte 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 orceps 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. Choudhry has no financial interests related to the article. Dr. Rosenthal has financial interests with Bausch + Lomb (Rochester, N.Y.), Alcon (Fort Worth, Texas), Abbott Medical Optics (Santa Ana, Calif.) and Rayner (East Sussex, U.K.). Dr. Miller has no financial interests related to this article. K10-1014 Set includes K4-5560, K5-7570 and a free sterilizing tray (K9-2024). fre ree -2 ® idea. But for those with early macular degeneration, it could have some value. Implanting a multifocal lens could purposely provide extra plus power at near and act as a vision aid with little loss of contrast sensitivity. Dr. Miller believes it's a bad idea for patients with macular disease to receive multifocal IOL implantations, but there are some exceptions. "Anything that's going to reduce contrast at the retinal level is a contraindication for a multifocal," he said. People with conditions like diabetes or vein occlusions should generally not receive multifocal IOLs, but he said if someone had a couple of drusen, this would not necessarily be a reason to not put in a multifocal IOL. There will always be hard exclusions, cases where there are no issues with putting in a multifocal IOL, and cases where a doctor has to exercise his or her judgment. Designed with Eric Donnenfeld, MD Rockville Center, NY 973-989-1600 r 800-225-1195 rwww.katena.com Contact information Choudhry: netan.choudhry@gmail.com Miller: kmiller@ucla.edu Rosenthal: kr@eyesurgery.org