Eyeworld

APRIL 2023 | EYEWORLD | 69 R by Ellen Stodola Editorial Co-Director About the physicians Cullen Ryburn, MD Vance Thompson Vision Billings, Montana Blake Williamson, MD Williamson Eye Center Baton Rouge, Louisiana T he options and strategies for mixing and matching IOLs have evolved over time. Two surgeons discussed their ap- proaches for using different lenses to help give patients the best outcomes. For Blake Williamson, MD, the first presby- opia-correcting IOLs he used were the ZKB00 and the ZLB00 (Johnson & Johnson Vision) when he was in training at Tulane University. "The very first patient I ever did a premium presbyopia-correcting lens on, I mixed and matched because the guidance I was getting from the surgical rep and my attending is you get the best of both worlds," he said. "We did a combination ZKB00 in the dominant eye and ZLB00 in the non-dominant eye." Since this was his approach from training, Dr. Williamson said this is likely why he's always been pro mixing and matching. "That's how I learned, so to me, it was never controversial," he said, adding that he isn't generally concerned about confusing the patient by having two dif- ferent lenses in the eye. "That never came into play because all we talked about to the patient was the desired outcome of having freedom from glasses and good functional vision at all ranges." After Dr. Williamson got out of training and into practice, the Symfony IOL (Johnson & Johnson Vision) launched. "This is a wonderful lens, but sometimes patients needed more near vision, and that's why I went back to doing the ZLB00 in the non-dominant eye and Symfony in the dominant eye," he said. Recently, Dr. Williamson's practice has gained access to the Synergy (Johnson & Johnson Vision). He has gotten good results with bilateral Synergy. It is an EDOF, but it has a very high add, so what he learned is that the distance vision isn't quite good enough for patients to be happy, he said. "I'm now using the Synergy OptiBlue in the dominant eye." With each new lens iteration, Dr. William- son said there's talk of "this lens is the perfect lens that can satisfy every patient at near and far," but what he's finding is that a combination seems to work the best. "Even with ongoing improvements in technology, and even with the current iterations, I find that my happiest pa- tients tend to have the mix and match technique applied to their vision," Dr. Williamson said. When discussing this with patients, Dr. William- son said he tells them that he's going to use a combination of lenses designed to give the best possible vision at distance and up close. In addition to the Johnson & Johnson Vision options that he tends to use, Dr. William- son said he has heard of colleagues using this approach with Alcon lenses. A lot of surgeons have had success with the PanOptix (Alcon) and the Vivity (Alcon), he said. With the PanOptix, sometimes the overall quality of vision may not be as good; the Vivity is similar to a monofocal, but you might not have near vision like with the PanOptix, he said. "I'm learning that a lot of colleagues are mixing and matching those two, where they'll do the Vivity in the dominant eye and the PanOptix in the non-dominant." Dr. Williamson called mixing and matching his "fastball for anyone who comes in and says that they don't want to have to wear reading glasses." But there are some patients who don't mind the possibility of wearing readers. Addi- tionally, Dr. Williamson said he will not use the Synergy lens in patients who are post-refractive, post-LASIK, or post-RK. In these cases, he will use bilateral Symfony because he likes that it has a wider landing range and is a bit more forgiving; for those patients, he doesn't offer mix and match. "The perfect candidate for mix and match is someone who has a healthy eye, virgin cornea, has not had prior refractive surgery, a healthy macula, and is wanting the best possible near vision without compromising too much dis- tance," he said. "That tends to be the majority of my patients wanting presbyopia correction. If they're going to pay that much money, most of them are sure they do not want to wear reading glasses as much as possible." Cullen Ryburn, MD, said that he used mix- ing and matching more in the past but doesn't use this strategy as much with current technol- ogy. "I most commonly mixed the ZKB00 and ZLB00 or ReSTOR 2.5 [Alcon] and ReSTOR 3.0 [Alcon] to give patients more glasses freedom," he said. When the Symfony lens came onto the market, there was a noticeable quality of visual Mixing and matching IOLs continued on page 70

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