Eyeworld

APRIL 2023 | EYEWORLD | 59 C Contact Riaz: Kamran-Riaz@dmei.org Tsai: tsai@wustl.edu Wang: liw@bcm.edu References 1. Choi A, et al. Accuracy of total corneal power calculation for multifocal toric intraocular lens implantation: swept-source OCT-based biometer vs Scheimp- flug tomographer. J Refract Surg. 2021;37:686–692. 2. Chung HS, et al. Comparing prediction accuracy between total keratometry and conven- tional keratometry in cataract surgery with refractive multifocal intraocular lens implantation. Sci Rep. 2021;11:19234. Relevant disclosures Riaz: None Tsai: None Wang: AcuFocus, Alcon, Carl Zeiss Meditec with the machine's IOL calculator, especially the Barrett formula. "For patients who have a history of refrac- tive surgery, I will review the Barrett True-K with TK and Haigis-L with TK, which are also included on the IOLMaster 700," Dr. Tsai said. "Then I will compare the results with the ASCRS IOL Calculator, which has shown to be the most accurate for these patients. Occasionally, I will use the ORA System [Alcon] in patients where I think additional information is preferred to obtain the highest accuracy in my results." Like Dr. Riaz, Dr. Tsai said she has also recently started using the ESCRS IOL Calculator, which gives the results of the Barrett, Cooke K6, EVO, Hill-RBF, Hoffer QST, Kane, and PEARL- DGS formulas. Once the IOL is implanted, all the physi- cians said there is a patient adaptation period. Dr. Wang said, "postop adaptation is a variable process that may depend both on the patient and the IOL design." She said it usually takes between 3–6 months. Dr. Tsai said she gives patients at least 3 months to adapt to the IOL technology, but she often encourages them to try up to a year if they're willing. Patients might need to adapt to color changes and positive and negative dyspho- topsias. She said that most patients will adapt to these visual phenomena, especially if their cata- ract was causing visual dissatisfaction preop. "If they have no improvement of symptoms by 3 months and are extremely bothered by visual quality, I would start the conversation regarding a possible IOL exchange. Luckily, I have not found that I've had to exchange many implants due to multifocal quality complaints," Dr. Tsai said. Dr. Riaz said that he also asks patients to take between 3–6 months to neuroadapt. With diffractive optics, Dr. Riaz said he considers objective measures (angle alpha being more than angle kappa) and subjective (assess- ment of personality types). In general, Dr. Riaz said he doesn't recommend IOLs with diffractive optics to patients with angle alphas more than 0.4 mm. He said personality is an even larger factor in his practice. "There are far too many practices where the surgeon only meets the patient on the day of surgery, and the IOL choice has been made by an optometrist or ancillary staff. The un- happy patients that present to clinicians are often burned by these experiences," he said. "Assessment of patient personality (type A, en- gineer, high demands for near vision, etc.) and This is a patient with good angle alpha and angle kappa values on ray tracing aberrometry (iTrace). Corneal higher order aberrations were less than 0.4 µm on Scheimpflug tomography (Pentacam). This patient is a potentially suitable candidate for diffractive optics presbyopia- correcting IOLs. Source: Kamran Riaz, MD continued on page 61

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