Eyeworld

opened new possibilities. Because patients do not have full accommo- dation with these IOLs, we focus the non-dominant eye with slight myopia to help expand the patient's range of vision. Preoperative examination During the preoperative examina- tion we provide a questionnaire ask- ing patients about their hobbies and occupations. Using a questionnaire increases efficiency. Topography and optical coher- ence tomography (OCT) should be performed in all premium lens can- didates (Figure 1). We must diagnose and treat preexisting conditions. For example, when examining candi- dates for accommodating IOLs, it is important to be alert for pseudoex- foliation syndrome. With the Trulign lens, I create an approximately 5.0- to 6.0-mm capsulotomy. I always use intraoper- ative wavefront aberrometry to align the lens and make sure the wound is tightly closed, possibly using a suture. We also need to follow our results and revise our nomograms as needed. If we have not reached our refractive target after surgery, I use the Toric Results Analyzer (astigmatismfix.com) to determine the best course of action. We can perform enhancements with laser vision correction if necessary. Z syndrome may occur in rare cases with accommodating IOLs, which may need to be corrected with a posterior or anterior YAG. If explantation is necessary, it may be challenging. Many baby boomers are high functioning and know a great deal about lens technology. We speak with them honestly about compro- mises they might need to make and what they will achieve with these IOLs (see box). We are alert for type A patients who are unwilling to compromise or accept some potential side effects. Accommodating lenses allow us to correct presbyopia in a broader range of patients, particularly if they are not good candidates for multifo- cal IOLs. To achieve patient satisfac- tion with accommodating IOLs, it is important to communicate with patients before surgery and ensure that their goals are realistic. Dr. Donaldson is associate professor of ophthalmology at Bascom Palmer Eye Institute, Plantation, Fla. She can be contacted at 954-465-2700 or kdonaldson@med.miami.edu. Figure 1. Corneal topography and OCT should be performed on all premium IOL candidates. In patients with macular pathology, as shown here, an accommodating IOL would be a better choice than a multifocal IOL. " Accommodating lenses allow us to correct presbyopia in a broader range of patients. " –Kendall E. Donaldson, MD, MS Supported by unrestricted educational grants from Alcon Laboratories and Bausch + Lomb 135

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