Eyeworld

EW FEATURE 118 Refractive options March 2015 by EyeWorld Staff intermediate, and near vision," he said. Survey respondents to the 2014 ASCRS Clinical Survey were asked the percentage of their cataract cases they target for monovision rather than implanting presbyopia-correct- ing IOLs (Figure 1). On average, U.S. respondents target for monovision rather than implanting presbyopia-correcting IOLs in their cataract cases nearly 50% more than non-U.S. respon- dents (26.7% versus 18.4%). U.S. surgeons target monovision in less than one-fifth of their patients. The difference in response between U.S. and non-U.S. surgeons is statistically significant. Dr. Dell noted that monovision is sometimes chosen for economic reasons. "Multifocal IOLs require substantial financial participation from the patient, and sometimes monovision with standard IOLs will suffice. The obvious disadvantages of monovision are difficulties with ad- aptation, loss of stereopsis, and the added chair time needed to explain it," he said. Satisfaction rates In the 2014 ASCRS Clinical Survey, members were also surveyed about how satisfied they are with current presbyopia-correcting IOL options (Figure 2). On average, physicians think their presbyopia-correcting IOL ASCRS members weigh in on presbyopia- correcting IOLs for cataract patients The 2014 ASCRS Clinical Survey data shows surgeons' preference for presbyopia-correcting options A chieving monovision with IOLs is a tried-and- true method for presby- opia correction. However, according to the respon- dents to the 2014 ASCRS Clinical Survey, many surgeons now prefer using multifocal or accommodating IOLs in this patient population. "Monovision is very effective for those patients who can adapt to it," said Steven Dell, MD, Dell Laser Consultants, Austin, Texas. "The acceptance of monovision is directly related to the degree of defocus used in the near eye. Accommodating IOLs provide some near vision on their own, so only a small additional amount of defocus is required to provide good near vision. In my experience, –0.50 to –0.75 D of defo- cus is very well tolerated and highly effective in this situation. Non-ac- commodating standard IOLs require more defocus than this, and some- times a contact lens trial is helpful in this situation. In the context of cataract surgery, this is sometimes impractical. "Ultimately, we need IOLs that achieve good uncorrected distance, Average U.S. 18.4% Non-U.S. 26.7% Overall 22.3% Figure 1. The survey asked, "What percentage of your cataract cases do you target for monovision rather than implanting presbyopia-correcting IOLs?" Average U.S. Non- U.S. Overall Near vision 7.2 7.6 7.4 Intermediate vision 6.2 6.0 6.1 Distance vision 8.3 8.2 8.3 Figure 2. The survey asked, "Overall, how satisfied are your presbyopia-correcting IOL patients with their outcomes at the following distances at 1-year postop?" (0=Least satisfied, 10=Most satisfied) Source: ASCRS 2014 ASCRS Clinical Survey

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