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EW MEETING REPORTER 114 Reporting from Hawaiian Eye 2015, Maui, Hawaii January 17–23 To attempt to fix the situation, Dr. Chang implanted a toric IOL in the eye with the cataract, and the patient ended up happy. To con- tinue to treat the patient, however, Dr. Chang had to decide what to do with the ReSTOR IOL, with the patient requesting an exchange. The patient ended up 20/20 plano in the eye with the toric and 20/20 in the eye that he ultimately used a monofocal in. Editors' note: Drs. Chang and Olson have no related financial interests. Dr. Talley Rostov has financial interests with Allergan and Bausch + Lomb. Dr. Lindstrom has financial interests with Abbott Medical Optics, Bausch + Lomb, and Alcon. Dr. Miller has financial interests with Alcon. Refractive IOL complications William Trattler, MD, Miami, gave an overview of enhancement op- tions for residual refractive error. Patients who are off target and unhappy following cataract surgery require a comprehensive workup looking at topography, OCT of the macula, and an evaluation of the ocular surface, Dr. Trattler said. To troubleshoot the unhappy IOL patient with residual refractive error, Dr. Trattler recommended optimizing the ocular surface and performing a YAG prior to laser vision correction. Additionally, enhancement options for these patients can be helpful, and the procedure of choice may be de- termined by the patient's residual refractive error, history of prior corneal surgery, and topography. Jack Holladay, MD, Bellaire, Texas, highlighted multifocal IOL dysphotopsia, a problem for patients with these lenses. The diffractive multifocal, which is most popular in the U.S., is really a bifocal intra- ocular lens, he said. It has 2 focal points, and one of the unavoidable problems is that the one image is always on top of the other. There is about a 30% loss of contrast and a halo around images, Dr. Holladay said. Although the halo lessens from neuroadaptation after surgery, it re- mains. His conclusion was that some light scatter is unavoidable, but some of it is avoidable by centering the lens halfway between the pupil and halfway between the vertex normal. Dr. Miller highlighted clinical pearls for dealing with unhappy refractive IOL patients. "With all multifocal lenses, we have reduced contrast," he said. There are also halos, difficulty reading under low light conditions, and optical aberrations if the lens is not centered in the pupil, he said. One of the keys with these lenses is determining who is the ideal candidate. Dr. Miller said this is simpler than you may think. The candidate wants spectacle indepen- dence, understands the limitation of the technology, can afford the cost, and has no ocular comorbidity. When determining these po- tential candidates, it is important to rule out certain patients based on contraindications for the lenses, which can include a monofocal lens in the fellow eye, a high amount of astigmatism in either eye unless you have a toric multifocal that can handle it, irregular astigmatism, previous keratorefractive surgery, a vision limiting ocular comorbidity in either eye, and any binocular vision disturbance. Dr. Miller also recommended avoiding multifocal IOLs with "potentially problematic conditions," like zonular dehiscence and posterior polar cataracts. Editors' note: Dr. Trattler has financial interests with Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, Im- primis, and Oculus. Dr. Holladay has no related financial interests. Dr. Miller has financial interests with Alcon. Lens and corneal refractive surgery complications Sonia Yoo, MD, Miami, moderat- ed the session on lens and corneal refractive surgery complications with 5 expert panelists. She dis- cussed a case of a patient who came to her office wanting refractive lens surgery. The patient had a previous procedure with a prolene suture implanted in the corneal stroma and was presenting for cataract evalua- tion. Dr. Yoo's question to the panel was which K measurements should be used if you have discrepancy between devices, which was her experience in this case. She used the Ks that were indicated from Tomey (Nagoya, Japan) and IOLMaster (Carl Zeiss Meditec, Jena, Germany) because these two were fairly consistent. She ran the IOLMaster with 2 toric lenses and picked the toric lens in each eye that View it now: Hawaiian Eye 2015 ... EWrePlay.org Sonia Yoo, MD, discusses the uses of intraoperative OCT during corneal surgery. continued on page 116 February 2015

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