EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1494912
APRIL 2023 | EYEWORLD | 89 G consider a trifocal IOL, depending on lifestyle, hobbies, age, and goals. "With consideration, I am also educating the patient thoroughly and having a conversation about glare and halos and contrast sensitivity, which is reduced with multifocal IOLs," she said. "We see, especially in mesopic conditions, that contrast sensitivity is affected." She would also consider placing a trifocal IOL in a patient with narrow angle glaucoma without retinal nerve fiber layer loss. "We know that cataract surgery can deepen the angle and stabilize IOP and has now been found to be preferred in patients with high IOP over an LPI," she said. In instances where there is certain ocular pathology—such as a mild epiretinal mem- brane, early-stage AMD, or glaucoma with little peripheral field loss—Dr. Ristvedt considers EDOF IOLs if the patient is motivated to have less dependence on glasses. The IOL design does not come without loss of contrast sensitivity, especially in mesopic conditions, so caution still needs to be taken, and these patients need to understand that they may not have as good near vision, she said. The more severe the glaucoma, the more risk for paracentral defects, as well as progres- sion leading to a need for additional glaucoma procedures. "With any IOL we place, we want to make sure the patient is going to enjoy the benefits and be able to utilize the technology," Dr. Ristvedt said. "If a patient has moderate to severe glau- coma, contrast sensitivity is already an issue. In these patients, I am looking at using an aspheric IOL to reduce spherical aberration and discussing getting the best quality of vision we can," she said. "I would still consider managing astigmatism through an IOL in moderate to severe cases." If a patient is more at risk for progression, Dr. Ristvedt avoids a diffractive and even an EDOF IOL, especially if the patient is at risk for a decline in foveal sensitivity. Using an en- hanced monofocal may be an option for moder- ate to severe glaucoma. continued on page 91 With glaucoma surgery performed in conjunction with cataract surgery, Dr. Ristvedt still uses technology for more precision in outcomes. Source: Deborah Ristvedt, DO