EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1540963
WINTER 2025 | EYEWORLD | 47 R Stage 1, Stage 2, and Stage 3 dysfunctional lens syndrome. "Showing them that and next a color slit lamp image of their lens, you can show them that there's some scatter, there's some yellow- ing," he said. Dr. Waring said due to an increase in public education, the pendulum has swung to the point where patients are coming in requesting custom lens replacement but are having to be recom- mended LASIK because they're not yet candi- dates. "Previously, we would turn them away for LASIK and recommend custom lens replace- ment. Now we have people coming in asking for custom lens replacement, but we're actually not recommending it," he said. Refining the DLS nomogram Since dysfunctional lens syndrome was original- ly proposed more than a decade ago, the nomo- gram for treating it has evolved dramatically, Dr. Waring said. "Like everything else in medicine, usually it starts in the most severe phases, and as the technology improves, the research improves, the innovation improves, and our confidence to deliver improves, the intervention moves further along earlier in the intervention cycle. That's exactly what we've observed with custom lens replacement," Dr. Waring said. When the DLS nomogram was originally conceived, corneal vision correction might have been recommended for the surgical correction of pure presbyopia. Dr. Waring said that now, more often than not, for patients who are plano presbyopes (J6 or worse), he's recommending custom lens replacement. "They still have great distance. They still have excellent quality of vision. They may be better than perfect uncor- rected, but they are fully dependent on reading glasses for everything that they do and are look- ing for a solution for their reading vision, so in the appropriate patient, we've moved to custom lens replacement as our primary procedure in the first stage of lens dysfunction." The innovations that have led to confidence in recommending custom lens replacement at earlier stages of dysfunctional lens syndrome continued on page 48 The dysfunctional lens syndrome graphic that Durrie Vision uses to show patients when comparing their Pentacam lens densitometry measurements Source: Jason Stahl, MD