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IOL patient. Kevin Miller, MD, Los Angeles; Richard Lindstrom, MD, Minneapolis; Audrey Talley Rostov, MD, Seattle; Randall Olson, MD, Salt Lake City; and John Vukich, MD, Madison, Wis., shared their thoughts on how they would approach this case. Dr. Chang first asked the audience whether there is a general time limit on how long you can exchange a multifocal IOL after surgery. Responses were across the board on exchanging up to 3 months, 6 months, or up to a year, and some responded that there was no time limit on an exchange or that they would refer this patient. These lenses can generally be taken out years later, as long as the procedure was clean, Dr. Miller said. However, he said if there was a lot of fibrosis and the zonules were loose, it is not a good idea. The patient that Dr. Chang was dealing with was a 71-year-old who had a ReSTOR lens (Alcon) implanted 2 years prior in one eye with a cataract in the other eye. The patient was bothered by imbalance, and the right eye, which had been operated on, was still blurry. Show- ing a picture of the patient's eye, Dr. Chang said the patient had a wrap around posterior capsule tear, and it appeared that the haptic was in the sulcus. Options included LASIK or PRK in the multifocal eye, exchang- ing the multifocal IOL, putting a multifocal in the second eye, or put- ting a monofocal in the second eye. Responses from the audience did not show a consensus on what the next step should be. Dr. Olson said it is important to know what the patient is unhap- py about in the first eye to know what to do with the second eye. Dr. Lindstrom added that it is also important to look further and check the ocular surface, topography, and higher order aberrations carefully. After looking at an iTrace (Tracey Technologies, Houston) analysis of higher order aberrations, Dr. Chang said it became apparent that the problems the patient was having were very real and that the higher order aberrations were com- ing from the internal optics. Dr. Talley Rostov said that this problem could potentially be from IOL tilt. An IOL exchange might be necessary because of image quality. She also said it might be helpful to ask the patient exactly what the complaint is and when it started, particularly if it happened after sur- gery, and whether it's getting worse. "Those things will give you a clue as to whether or not this is an IOL that needs to be exchanged," she said. continued on page 114 View it now: Hawaiian Eye 2015 ... EWrePlay.org Eric Donnenfeld, MD, discusses preoperative measurements and management of ocular surface disease in the cataract patient.

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