Eyeworld

R WINTER 2024 | EYEWORLD | 51 develops. A cataract is not a disease but part of the aging process. With RLE, we are preventing cataract formation and restoring vision from distance all the way to the cellphone without glasses.'" Dr. Hamilton's practice website has a section that discusses options for patients at var- ious ages. The under 40 page has information on LASIK, SMILE, and the EVO (STAAR Surgi- cal), while the over 50 page discusses options like RLE, laser cataract surgery, and the LAL but does not include LASIK. Patients in their 40s–50s require individualized care. Some of the most ideal patients for RLE, he said, are the hyperopes because they were used to not wearing glasses and now are dependent on them at least for near vision and often for distance. They are delighted to get back the unaided near and distance vision. "One of the reasons why I am much more enthusiastic about RLE now is because we have amazing lens implants," Dr. Hamilton said, adding that he is also excited about the TECNIS Odyssey, which he called "incredible in terms of distance, intermediate, near, and minimizing nighttime halos." For patients in their 40s and early 50s, quality of vision is still quite good because there is not much nuclear sclerosis. Therefore, they are expecting not to lose this quality with RLE. Some of the multifocal lenses have contrast sensitivity issues that may not be acceptable to patients in their 40s and early 50s from a quality of vision standpoint. "I have not found that to be the case with the TECNIS Odyssey," he said, noting that this lens is only available in a limited market release right now, but he has been using it since April 2024. "It has been transformational to me in terms of RLE." Dr. Hamilton also likes to use the LAL in patients who have had previous refractive surgery. "The best patients are the ones who have had previous hyperopic LASIK and patients with smaller pupils," he said. "They get amazing results from the LAL. The patients who don't get as much range are the ones with big myopic corrections and larger pupils." The LAL is still a great choice for post-LASIK patients with myopic corrections, but you have to set the expectations, he said. It's going to be blended vision; the two eyes will be different. The patient will decide how much near vision they want in exchange for distance quality. The myopes are a different breed from hyperopes. They come in because they're taking glasses off to read for the first time, Dr. Hamil- ton said. "If someone in their late 30s or early 40s comes in with a –7 and I do LASIK on them, it changes corneal optics in a negative way. I'm going to create too much positive spherical aberration. Now in 5–6 years, they'll come back and say the LASIK wore off, but I'm going to say that we talked about that LASIK is not the final solution. I won't have as many options for that patient because we did LASIK and created op- tics not compatible with some options, like the multifocal lens. This is another reason why I'm not doing LASIK in patients with high myopic corrections in their late 30s and early 40s." For these patients Dr. Hamilton prefers to use the EVO. "I can put the EVO in, I haven't altered the corneal optics, and when they come back in 5–10 years for RLE, we have more options available," he said. Dr. Rebenitsch said the best education happens even before patients come through the door. "It's important to have this information on your website and in marketing materials that there are solutions beyond LASIK," he said. In terms of RLE candidacy, Dr. Rebenitsch said it's the same evaluation for cataract surgery for candidacy for multifocals. The technol- ogy, he continued, is even more important in RLE because this is elective surgery. "The continued on page 52 TECNIS Odyssey IOL implanted during RLE surgery Source: D. Rex Hamilton, MD

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