Eyeworld

EW FEATURE 114 Refractive options March 2015 by Ellen Stodola EyeWorld Staff Writer excellent technology, but they do have their limitations. Aligning expectations is key." Potential complications The complications seen with the different IOLs vary, Dr. Dell said. As extended depth of focus and the first extended range of vision IOLs are not available in the U.S., the lack of clinical experience here with these lenses also has to be considered. However, those doctors working with extended depth of focus lenses outside the U.S. have reported dis- tance quality similar to a monofocal IOL, with an expanded range of cal outcome, as well as the patient's quality of vision. Dr. Gupta thinks it is also im- portant to preoperatively anticipate any residual refractive error. This can be difficult to do, but there are steps surgeons can take preoperatively such as looking at the amount of corneal astigmatism and having a plan for managing that, she said. "In terms of patient candidacy, some practices will use a question- naire to identify patients' goals," she said. "I think that works well but you still need to talk to your patients so they understand that multifocal and presbyopia-correcting IOLs are It's important for surgeons to discuss and appropriately handle complications A ccommodating, multifo- cal, extended depth of fo- cus, and the first extend- ed range of vision IOLs are options for presbyopic patients, but each of these tech- nologies comes with its own set of concerns and specifications. Patients should be carefully selected prior to surgery for best outcomes, while also being made aware of complications that could arise. Preeya Gupta, MD, Durham, N.C.; Steven Dell, MD, Austin, Texas, and Eric Donnenfeld, MD, Rockville Centre, N.Y., discussed different types of IOLs and how to handle possible complications in these patients. "I think the most common rea- sons that patients are unhappy after these lenses is residual refractive er- ror, dry eye, and not having proper expectations," Dr. Gupta said. "The best way to avoid any of these is to do a very thorough preoperative assessment." In addition to a thorough clinical examination and obtaining refractive data, it's important to look for dry eye symptoms. She is particu- larly aggressive about addressing this problem before surgery because it can impact the biometry and surgi- Managing patients with presbyopic IOL complications Monthly Pulse Keeping a Pulse on Ophthalmology T he topic of this Monthly Pulse Survey was "Refractive options." We asked about the best way to surgically treat presbyopia in a patient with a cataract, and the most popular re- sponse was a multifocal IOL. When asked about the best way to surgically treat presbyopia in a 50-year-old +1.00 D patient without a cataract, the majority of respondents said LASIK with monovision; a clear lens extraction with a presbyopic IOL was the second most popular answer. We asked physicians if they preform any preoperative testing when patients are interested in a multifocal IOL, and the majority said all of the above: dry eye and ocular surface testing and macula OCT. Finally, when asked about the maximum amount of astigmatism tolerated by patients who have had presbyopic IOL implantation, the majority of respondents said 0.50 D. AT A GLANCE • Presbyopic IOLs each have their own set of potential complications for patients. • Managing the ocular surface prior to implanting these IOLs is critically important because poor ocular health can cause inaccurate measurements and poor vision quality, among other problems. • Explanting these IOLs is possible, but the physician should carefully consider all options before making that decision. Punctate corneal staining in a patient post-multifocal IOL

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