Eyeworld

EW NEWS & OPINION 28 the latter, as I don't think he will ever be happy with a MF considering the natural tendency of the Meesman's to recur." Brad Oren, M.D. Treatment Given the finding of Meesmann's, I discussed the options with the pa- tient. Although superficial keratec- tomy could eradicate the cysts temporarily, they do recur, and this is really a treatment more effective for the recurrent erosion symptoms associated with Meesmann's than to deal with any visual problems, which will most definitely recur over time. Given that this patient was from a 4-hour drive away, I did not feel it would be a productive experi- ment to try this. It has been reported that soft contact lens wear will reduce the number of cysts in Meesmann's (www.ncbi.nlm.nih.gov/pmc/arti- cles/PMC1298733/pdf/taos00015- 0195.pdf), and I offered this option to the patient, but he did not wish to try it. After discussing the various options the patient decided that he wished to move forward with an in- traocular lens exchange with a stan- dard monofocal aspheric implant. The option of the Crystalens was discussed but given that the previ- ous surgery was done 1 year before, I did not feel I could guarantee a good accommodative outcome and we thus decided against it. Here is a link to the video of the surgery: www.youtube.com/ watch?v=wujJw_YPfHE. The patient experienced imme- diate resolution of his visual com- plaints after the surgery and is now happy with the quality of his vision. No treatment of the cornea was re- quired. "Any corneal findings that af- fect the path of light, such as Fuchs,' EBMD, hereditary disorders, DES, ir- regular astigmatism, large vitreous floaters, and so forth are a con- traindication to multifocal IOLs due to their adverse effect on MTF (mod- ulation transfer function). One has to wonder how the vacuoles forma- tion in AcrySof [Alcon] material af- fects the MTF also. Despite what is espoused, it is very difficult to accept that this has no affect on MTF." Ed Hedaya, M.D. Take-home points I feel this case illuminates several important points. The first is that al- though we've all become more aware of the importance of testing such as topography and OCT to help us better understand our premium IOL patient outcomes, we can't over- look the importance of a careful clinical examination to pick up the things that testing simply can't. In this case a careful slit lamp exam picked up the pathology that was missed on testing. The second point is that the vi- sual function of patients with dif- fractive multifocal implants is more "labile" or easily and significantly degraded by processes that would be relatively insignificant otherwise. These may include relatively mild astigmatism, posterior capsule haze, dry eye, and epithelial abnormalities that might be asymptomatic in a phakic patient or a patient with a monofocal implant. When we evalu- ate patients for a multifocal implant, it is wise to carefully evaluate them not just for existing pathology but also to consider what pathology they may face down the road as they get older in an actuarial analysis of risk benefit ratio of the lens for pa- tients as they age. EW Editors' note: Drs. Baratz and Kim have no financial interests related to this case. Dr. Whitman has financial interests with Alcon and Bausch & Lomb and does research for ReVision Optics (Lake Forest, Calif.). Contact information Safran: safran12@comcast.net October 2011 Femtosecond Thorlakson Eye Speculum Adjustable mechanism 10mm rounded wire blades designed to accommodate the suction ring of the FEMTO LVD TM laser. Thorlakson Z-LASIK TM Flap Lifter Combines a 1mm long, extra ne modied Sinskey Hook and a 12mm long bi-convex spatula with beveled notches. To lift LASIK aps created with a femtosecond laser. IntraLase® Flap Lifter Combines a 1mm long Sinskey Hook for nding the ap edge and a long, blunt, 11mm long hook to undermine the ap perpendicular to the hinge. INSTRUMENTS 973-989-1600 r 800-225-1195 r www.katena.com ™ emtosecond emtosecond emtosecond emtosecond F emtosecond emtosecond emtosecond emtosecond emtosecond emtosecond emtosecond emtosecond emtosecond A multifocal continued from page 27

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