Eyeworld

38 | EYEWORLD | WINTER 2024 ATARACT C Contact Khandelwal: Sumitra.Khandelwal@bcm.edu Lee: bryan@bryanlee.pro Shamie: ns@maloneyshamie.com Strange: tbstrange1@gmail.com creates an extended depth of focus, similar to what you see with a monofocal plus," she said. She also offered a few patient-specific pearls: • Advise patients with astigmatism that for 2–3 weeks after surgery, they'll be living with a bit of blur as the lens prior to the adjustment is essentially a monofocal IOL. • Post-RK, post-hyperopic LASIK, and post-hy- peropic PRK patients can take longer to stabilize after cataract surgery, so Dr. Shamie advised delaying adjustments by at least 5 weeks and separating light adjustment by 2 weeks. In post-myopic LASIK/PRK or eyes with no prior history of corneal-based surgery, Dr. Shamie's practice begins light adjustments 3 weeks after surgery with eyes spaced 1 week apart. • For patients who haven't tried monovision or don't want to consider it, who hate glasses, and are seeking a fuller range of vision, she recommends a multifocal IOL, rather than the LAL or LAL+. • Avoid the LAL in patients who don't dilate well and those with suboptimal vision poten- tial, such as patients with mild to moderate AMD or with epiretinal membrane. These patients are investing time and money in the advanced technology, and if the eye's vision Light Delivery System, and adjust the lens to compensate for the refractive miss. In doing so, more than 98% of patients reach their refractive target," Dr. Shamie said. However, there were many lessons learned in using the lens effectively in their practice. Clinic flow was the biggest hurdle. Dr. Sham- ie said she was doing her own adjustments initially (and she recommends those starting out with the lens do 10–20 adjustments to understand the nuances of it), but she has since trained internal ODs to perform the adjust- ments. Adjustments only take about 2 minutes, but the workup to prepare the patient for the light adjustment requires a discussion about target planning, then a manifest refraction and dilation. "Optometrists who are in surgical practice working closely with cataract surgeons are very well equipped with what's required to do the light adjustments. The most difficult part is not the light adjustment but the target planning for the patient. After we decided to have our inter- nal ODs do the light adjustments, it was a much smoother process," she said. Dr. Shamie said it's important to inform pa- tients preop that light adjustment specialists will be managing adjustments after their surgery. Another lesson was the education required for the staff about the value of the lens. "Everyone had to be educated about the unique nature of this technology. We needed them to be enthusiastic about the opportunity it was adding to optimize patient outcomes and improve the quality of vision patients could achieve. They saw our cataract patients were achieving uncorrected vision of 20/20 and sometimes 20/15 and were ecstatic, so after a little while, it spoke for itself," Dr. Shamie said. Referring doctors also had to be educated on how the postop period and comanagement is different for this lens. "After empowering and educating the referring doctors and demonstrat- ing to them the value added to their patients, … they became vested in the process," she added. Over time, Dr. Shamie said her practice changed their initial refractive targets with the lens, now targeting slightly plus to then adjust postop toward minus for a slight extended depth of focus effect. "When you treat the lens to shift toward myopic, the light treatment to change the refractive power of the lens centrally continued from page 37 continued on page 40 " Patients need to understand they may not get the near vision they were thinking they were going to get, and they may not get the trifocality in both eyes. I think telling them that upfront and getting them locked in in a timely manner is helpful." —Sumitra Khandelwal, MD

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