MAR 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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I have had predictable results with about 90% accuracy in my cases so far. Counseling these patients and downplaying their expectations of spectacle independence is extremely important. I usually educate the pa- tient on the difficulties of IOL power c alculations and the possible need for IOL exchange or laser enhance- ment surgery to correct any refrac- tive surprise. These refractive surgery patients are likely to demand specta- cle independence for both distance and near more so than other pa- tients, and the topic of multifocal lens implantation is often unavoid- able. I generally prefer not to i mplant multifocal IOLs in these patients, as the visual results can be unpredictable. In particular, I avoid multifocal IOLs in patients with increased higher order aberrations and decentered ablations following refractive surgery. When choosing the intraocular lens power, it is better to aim for slight myopia. In the event of a re- fractive surprise, myopic corrections tend to be more predictably cor- rected with laser enhancement sur- gery, which is my preferred method over IOL exchange. For surgeons without access to an excimer laser system, IOL exchange will then have to be performed, and this should be done sooner rather than later fol- lowing the initial cataract surgery. Dr. Lawless: The authors have raised many issues for surgeons having to deal with cataract calculations in patients who have had previous laser corneal surgery. It needs to be understood that some devices are robust, and these include the IOLMaster (Carl Zeiss Meditec, Jena, Germany), LENSTAR (Haag-Streit, Mason, Ohio), and manual and automated keratometry. March 2014 D evices such as Pentacam (Oculus, Arlington, Wash.) and Orbscan (Bausch + Lomb, Rochester, N.Y.) are not as robust and make more as- sumptions, which can be misleading in post-refractive cases, and need to be used with caution in this setting. Some of the information given is valuable, such as helping to confirm t he axis of astigmatism. Not all post laser refractive pa- tients are the same. Those treated for higher refractive errors with older technology will have a differ- ent corneal higher order aberration profile, and this needs to be consid- ered when deciding which IOL to use. The general rule is that the more corneal HOAs, the less likely y ou are to use a multifocal lens. We also need to have a way out of refractive surprises, even more so than in normal patients, so deter- mine if they would be suitable for an enhancement prior to cataract surgery. Of interest here is that about 75% of patients in this category will end up within half a diopter of intended on spherical equivalent, which means approxi- mately one in four patients will need an enhancement of some sort. Results within half a diopter of in- tended also do not tell the full story, as some of these patients can be within this range on sphere, but have a troubling 0.75 or 1.00 D of astigmatism remaining, which means that the results are not quite as good as the spherical data would suggest. EW Editors' note: The physicians have no financial interests related to this article. Contact information Chan: cordelia_chan@snec.com.sg Lawless: Michael.lawless@visioneyeinstitute.com.au We're about to shake up the dry eye industry. We hear you. Treating chronic dry eye shouldn't be complicated, painful or expensive. To prove it, we'll be introducing several innovative products in the coming months. Lacrivera. You'll want to keep an eye on us. A F R E S H P E R S P E C T I V E ™ © 2014 Lacrivera. All rights reserved. 2 500 Sandersville Rd ■ Lexington KY 40511 USA lacrivera.com ( 855 ) 857-0518 . s e on u . s h e on u y n e p a ee o k t t n a l w t on ng m i om e c h n t s i t uc ™ E V T I C P E l w l ' u o Y Yo . a r e v i cr a L uc d o r e p v i t a v o n n i P E S R P E H S E R F A s h . e v i s n e p t on ng m i om e c h n t s i t uc l a r e v e ng s i uc d o r t n e i l b p x l or e u f n i a , p ed t a c i l p om e y y e r c d i on r h ng c i t a e uc d o r e p v i t a v o n n i l b l ' e , w t e i v o r o p T om e c t b ' n d l u o h s e r T u. o y r ea h e W y. e y y e y. r t s u y e r d u d n i ke a he t a h s p u d o ke a o t t ou e 'r a h s ou ab e W W L ac c r i v ve r a _ S h a k e U p - E W . i n d d 1 Lacr vera ShakeUp EW indd 1 1 1 2 2/ /1 4 4/ 1 4 4 : 4 46 P 2/14/14 4:46 P P M PM Views continued from page 147 144-148 International_EW March 2014-dl2_Layout 1 3/6/14 7:32 PM Page 148

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