Eyeworld

EW FEATURE 30 by Maxine Lipner EyeWorld Senior Contributing Writer Paying the premium lens piper How much residual error is acceptable? T here was a time when cataract patients were relatively easy to please— willing to wear glasses if necessary following surgery. But what about premium refractive IOL patients today? If you want to maximize satisfaction and minimize visual symptoms, patients nowadays will tolerate surprisingly little residual refractive error, according to Steven C. Schallhorn, MD, professor of ophthalmology, University of California, San Francisco; medical director, Optical Express, Glasgow, U.K.; and in private practice in San Diego. In a paper presented at the 2014 ASCRS•ASOA Symposium & Con- gress, Dr. Schallhorn described just how little room for error there is. "Even 0.5 D of residual astigmatism can lessen the chance that the pa- tient will achieve 20/20 uncorrected vision, decrease patient satisfaction, and increase the chances that the patient will have visual disturbances such as glare and halos," Dr. Schallhorn said. "That is a big paradigm shift over the last one or two decades when a refractive out- come within 1 D of emmetropia was considered an excellent outcome." Tolerance issues "Especially with premium IOLs, there are rising expectations and in- creasing patient demands; even 0.5 D of astigmatism may not be accept- able to the patient," Dr. Schallhorn said. "Many clinicians may not realize that certainly 1 D of astigma- tism and even as little as 0.5 D can have an impact." Keratorefractive enhancement of pseudophakes July 2014 AT A GLANCE • With premium lenses, tolerance for residual sphere or cylinder can be as low as 0.5 D. • Patients with multifocal lenses tend to be the least forgiving of residual error, while those with accommodative IOLs are the most. • When it comes to residual astigmatism, if it is oblique or the patient's pupil is large, the need for an enhancement may be greater. Even a little residual astigmatism may require toric IOL rotation. Source: John Berdahl, MD 30-37 Feature_EW July 2014-dl_Layout 1 6/30/14 8:42 AM Page 30

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