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EW MEETING REPORTER 22 December 2011 tient decided to have her monofocal implants exchanged for multifocals after being dissatisfied with her near vision—so bad, the patient said, that when eating without spectacles, food no longer looked appetizing. What Dr. Bissen-Miyajima took from that experience was to ask, "What is most influential in your life—glare, halos, and similar disturbances or a wide range of vision including near without spectacles?" Ultimately, she said, patient selection is the key to success. Joint Plenary Session addresses worldwide presbyopic solutions Presbyopic solutions, such as accom- modative intraocular lenses, mono- vision, and intracorneal inlays, and their benefits and drawbacks were the focuses of the combined sympo- sium of ASCRS, APACRS, and the European Society of Cataract and Re- fractive Surgeons titled, "Presbyopic Solutions: Potential and Pitfalls." Stephen Lane, M.D., Stillwater, Minn., discussed the differences and pros and cons of multifocal IOL of- ferings in the U.S., such as the Tecnis (AMO) and ReSTOR (Alcon) lenses. "The biggest advan- tage of multifocal lenses is their ca- pacity to give very sharp near and distance vision," Dr. Lane said. "They are capable of doing that be- cause of the way in which the mech- anism of action works. Essentially, it's a splitting of light. The splitting of light can lead to visual distur- bances that seem to be more preva- lent in some patients than others. The problem is it's very difficult to know ahead of time which ones are going to have a problem and which ones are not. A lot of it de- pends on the patient's social needs and desires." Dr. Tchah introduced attendees to neuroadaptation in his talk, "Multifocal IOLs: Binocular vs. Monocular." He went over the re- sults of a study comparing and con- trasting the two, concluding that both monocular and binocular mul- tifocal IOL implantation showed good distance and near uncorrected visual acuity. Halo and glare were not severe and were well tolerated. "To implant multifocal IOLs in pa- tients with monocular cataract seems to be a good option," he said. In the presentation "Ocular Surface Considerations in Presbyopia and Astigmatism Correc- tion," Sonia H. Yoo, M.D., Miami, explained how to manage patients with common ocular sur- face diseases, specifically dry eye. "It is estimated that 11% of patients be- tween ages 30 and 60 suffer from dry eye," she said. "One of the prob- lems is tear film deficiency can inter- fere with the ability to accurately measure keratometry. It can be diffi- cult to obtain an accurate IOL calcu- lation." Because patients can be asymptomatic, Dr. Yoo recom- mended looking for autoimmune diseases such as Lupus, a history of radiation, and prescription drug usage such as antidepressants and Parkinson's disease agents. Dr. Gatinel discussed the different types of intracorneal lenses, including the Flexivue Microlens (Presbia, Los Angeles, Calif.), the KAMRA (AcuFocus, Irvine, Calif.), and the Vue+ (Revision Optics, Lake Forest, Calif.). The KAMRA has well- known principles and "improves near vision but has a limited impact on distance vision," Dr. Gatinel said. Benefits of the KAMRA are that it has a reproducible technique, a broad indication range, and is ad- justable. Longer-term studies are needed, he said. Approaching astigmatism with IOLs Toric IOLs, said Edward Holland, M.D., Cincinnati, are the best op- tion today for correcting high astig- matism after cataract surgery. He was speaking at a cataract sympo- sium on "Corneal and IOL Ap- proaches to Correcting Astigmatism." Patients who received the AcrySof IQ Toric IOL (Alcon) had significantly better spectacle-inde- pendent distance vision than equiv- alent counterparts who received relaxing incisions. Ronald Yeoh, M.D., Singapore, has used the as- pheric apodized diffractive multifo- cal IOL (Alcon) in his practice. Out of 24 eyes implanted with the lens, 15 had 6/6 or better unaided dis- tance vision, while 18 had J1 or N4 unaided near. The key is precision. Devices like the ORange Wave- front Aberrometer (WaveTec Vision, Aliso Viejo, Calif.), the Surgical Guidance System (SensoMotoric In- struments, Teltow, Germany), and an intraoperative keratometry device currently being investigated by Tetsuro Oshika, M.D., Tsukuba, Ibaraki, Japan, are now available to help surgeons achieve optimal re- fractive outcomes. October 15, 2011 Michael Knorz, M.D., Mannheim, Germany, described two intrastro- mal techniques utilizing the femtosecond laser: INTRACOR and SUPRACOR (Technolas Perfect Vision, Munich, Germany). INTRACOR uses the laser to create a Reporting live from the Asia-Pacific Association of Cataract & Refractive Surgeons meeting, Seoul, South Korea APACRS President Graham Barrett, M.D., presents the Lim Lecture award to Hiroko Bissen-Miyajima, M.D. continued on page 24 Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2011 APACRS meeting, Seoul, South Korea.

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