Eyeworld

EW RETINA 132 March 2015 by Ellen Stodola EyeWorld Staff Writer Preoperative OCTs for multifocal patients no complications but end up having a mild epiretinal membrane or some macular changes that were not seen beforehand, he said. "Unfortunately, in ophthalmol- ogy in general, we have a metric, which is visual acuity, that is not as applicable in the real world as an- other metric that we should have," Dr. Dugel said. Distortion is what needs to be measured in patients, but there is no way to quantify or standardize this. Even if someone has 20/20 vision and a successful surgery by the surgeon's standards, the patient could still have some dis- tortion. The visual acuity measure- ments are artificial, Dr. Dugel said. Another reason it is import- ant to do a preoperative OCT is because of the way that multifocal IOLs work. "Most of these IOLs are diffractive IOLs and because of the optics involved, if you have some distortion, that distortion will often- times get magnified," Dr. Dugel said. "That distortion, because of the dif- fractive nature of the IOL, becomes much more bothersome." Determining retinal pathology prior to implanting a multifocal IOL can help with patient satisfaction W hen implanting a mul- tifocal IOL (MFIOL), it is vital the patient be a good candidate, so a careful preoperative examination is necessary. This may include optical coherence tomogra- phy (OCT) to check for any macular pathology or retina problems. Carl Regillo, MD, Mid Atlantic Retina, Philadelphia; Jeffrey Heier, MD, Ophthalmic Consultants of Boston; and Pravin Dugel, MD, Retinal Consultants of Arizona, Phoenix, spoke about important things to know about a preop examination. Should OCT be obtained preop on MFIOL candidates? Dr. Regillo thinks an OCT should be obtained preoperatively on candidates for a multifocal IOL. "It is useful in identifying subtle macular pathology, such as epiretinal mem- branes and mild surface wrinkling that could adversely impact the visual outcomes with [a multifocal IOL]," he said. "If such pathology is present, it may be best to avoid these types of lenses." Dr. Heier agreed that a preopera- tive OCT is important for candidates of these specialized implants because any retinal disease could significant- ly impact patient outcomes. "Retinal disease can be very difficult to detect in the presence of a cataract," he said. "In fact, it can be difficult to observe even without a cataract." He added that doing a preoperative spectral domain OCT is important, and that a volume scan and not just a line scan is key to help detect pathology in the macula. Dr. Dugel also thinks a preop- erative OCT should be obtained for these patients. Some of the most un- happy patients are those who have a multifocal IOL, good vision, and underwent successful surgery with R efractive cataract surgery represents a great advance in both technology and outcomes for patients that was unavailable just a few years ago. With the advent of multifocal lens technology and femtosecond laser-assisted cataract surgery, expectations of the physician and patient are at an all-time high. Accordingly, the greatest challenge for our anterior segment colleagues is providing realistic postoperative expectations for their pa- tients. This challenge is complicated by the fact that many patients undergoing cataract surgery today will have associated retinal comorbidities, some that are not easily recognized preoperatively. Failure to detect these disorders can lead to suboptimal outcomes and unhappy patients. A careful preoperative examination of the retina is an important tool in assisting the anterior surgeon in meeting that chal- lenge. In this "Retina consultation corner," Jeffrey Heier, MD, Pravin Dugel, MD, and Carl Regillo, MD, discuss the preoperative retina exam and which modalities are the most effective in the evaluation of patients undergoing refractive cataract surgery. In addition, they provide insight into the utility of multifocal lens technology in patients with macular disease. Keith A. Warren, MD, Retina consultation corner editor OCT of an epiretinal membrane Source: Pravin Dugel, MD Retina consultation corner

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