Eyeworld

FALL 2024 | EYEWORLD | 33 C Contact Ang: rtang@asianeyeinstitute.com Fram: drfram@avceye.com Relevant disclosures Ang: Bausch + Lomb Fram: Bausch + Lomb "If the dominant eye qualifies for the IC-8 Apthera, and that's the only lens that will cor- rect the irregular cornea, I choose to do a bilat- eral approach," Dr. Fram continued. If you leave the dominant eye with an IC-8 Apthera and the non-dominant eye with a monofocal, you run the risk of the patient noticing more of the dimming effect. Conversely, if the non-dominant eye has an IC-8 Apthera, you can use a regular monofocal in the dominant eye without issue. Dr. Fram said the "moral of the story" is that there have been some interesting developments in off-label applications of the IC-8 Apthera in a population that did not previously have a lot of hope or options. "We also are learning about the adaptation to the dimming through trial and error of who tolerates the dominant eye having this technology," she said. It is important to counsel patients ahead of time there is a small chance you may have to remove it because of dimming. "With irregular corneas, you need to make sure the scarring is not in the central 1.6- mm zone, and if there is a chance the patient needs the small aperture in the dominant eye, consider off-label bilateral implantation. You want the pupil to dilate to at least 6.5 mm be- cause you need to get around the inlay to do the YAG so you don't hit the inlay inadvertently," Dr. Fram said. Dr. Ang also discussed some of the same off-label applications of this lens that Dr. Fram highlighted. Use of the IC-8 Apthera on com- plex corneas is becoming accepted because it improves the quality of vision of aberrated corneas, he said. The more aberrated cornea may not be the non-dominant eye, and in some instances, like bilateral RK eyes, both eyes will benefit from the IC-8 Apthera, so bilateral use can be acceptable. In terms of counseling patients on this tech- nology, Dr. Ang said he describes the drawbacks of this lens similar to monovision. "I say, 'One eye gets better far vision, while in the eye with the IC-8 Apthera, you will sacrifice some sharp- ness and brightness to gain intermediate and some near vision.' If they are OK with this, we proceed." For targeting, Dr. Ang said the sweet spot of the lens is to achieve a mildly myopic outcome of MRSE –0.50 D to –1.00 D. "From my experience, these patients are the most satis- fied," he said. It's also important to be sensitive continued from page 30 Nd:YAG posterior capsulotomy image of the intentional hinge left from 5–7 o'clock Source: Nicole Fram, MD to posterior capsular opacity. "If there is a grade 1 opacity within the aperture, and the patient notices a change in vision, whether distance or near, I proceed with YAG capsulotomy, which can be as early as 6 months postoperative," he said. Dagny Zhu, MD, Cataract Editorial Board member, shared how she has knocked down clinical and surgical challenges: 1. Reverse optic capture can be useful for treating complaints about negative dysphotopsia post-premium IOL cataract surgery. 2. Assembling preop dry eye kits for patients to purchase beforehand may decrease post-cataract dry eye complaints. 3. YAG laser vitreolysis can effectively treat floater complaints post-cataract surgery. (For more on this, see "Floaters getting in the way of postop patient happiness?" on page 34.) S t r i k e !

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