Eyeworld

World view An unmet need T here are very few guarantees in life. I have heard pundits state the only guarantees in life are death and taxes. To this short list I would add presby- opia. Two defining ophthalmic mo- ments in our lifetime identify middle and old age, respectively: the onset of presbyopia and the need for cataract surgery. Baby Boomers fight the aging process, and for this reason presbyopia is an enormous unmet need for many of our patients and is the final frontier for most anterior segment surgeons. There are an enormous number of options for dealing with presbyopia. The most common solution is a pair of reading glasses. Monovision contact lenses and multifocal contact lenses have their advocates, but more and more patients are seeking a surgical solution to this universal problem. The number of surgical options has grown markedly over the past several years, and there are even more options in the research and development pipeline. The numerous options highlight the basic premise that there is no perfect answer. Each one has advantages and disadvantages that require consideration by both the surgeon and the patient. For this rea- son, as the options have expanded so has my informed consent process. The discussions can at times become dizzying as we explain the strengths and weakness of the different procedures. In my experience, my multifocal IOL patients are by far the happiest and most unhappy patients in my practice. The patients whose expectations have been met or exceeded are extraordi- narily happy, while the patients who cannot tolerate halos are miserable, and it is almost impossible to differentiate these patients preoperatively. Monovision has a loss of stereopsis and depth perception so that nothing is perfect, and the current generation of accommodating IOLs has less accu- rate distance correction and less reading ability but better quality of vision. Multifocal corneal ablations and corneal inlays are promising but have not been used extensively in the U.S. In this issue of EyeWorld, Richard Lindstrom, MD, Jeffrey Whitman, MD, Vance Thompson, MD, and John Doane, MD, discuss several corne- al inlays that are nearing Food and Drug Administration (FDA) approval. Multifocal IOLs have improved dramatically over the last several years, and Robert Weinstock, MD, Douglas Koch, MD, and Bonnie An Henderson, MD, will tell us about new improved technologies such as low add aspheric multifocal IOLs and new toric multifocal and accommodating IOLs. Louis "Skip" Nichamin, MD, Dr. Weinstock, and Mark Packer, MD, look into the future and tell us about the pipeline of accommodating IOLs on the horizon. Dr. Koch, Jack Holladay, MD, and I have just finished the FDA trials of a new class of presbyopic IOLs called extended range and depth of focus lenses that provide reliable near vision without halos, and we will hear about these exciting new lenses. Preventing patients from becoming unhappy with presbyopic IOLs is extraordinarily important. Optimizing the ocular surface, reducing astig- matism to the lowest levels possible, and evaluating macula function are all important in improving presbyopic IOL results and patient satisfaction. Preeya Gupta, MD, Steven Dell, MD, and I will provide pearls that apply to not only presbyopia IOL patients but all cataract and refractive patients. In my experience, the management of the presbyopic patient is one of the most challenging but rewarding opportunities in ophthalmology. I look forward to the development of new technologies that will offer a cure for this universal problem. EW Eric D. Donnenfeld, MD, refractive editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S March 2015 Volume 20 • No. 3 Publisher Donald R. Long don@eyeworld.org Editorial Editor Erin L. Boyle erin@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Staff Writer Ellen Stodola ellen@eyeworld.org Staff Writer Lauren Lipuma lauren@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Fla. Michelle Dalton Reading, Pa. Matt Young Malaysia Enette Ngoei Dublin Rich Daly Arlington, Va. Senior Contributing Writer Maxine Lipner Nyack, N.Y. 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