Eyeworld

EW CATARACT 33 December 2015 negative corneal spherical aberra- tions. With this in mind, he prefers a lens that's aberration-free, like the enVista (Bausch + Lomb, Bridgewater, N.J.) or the Akreos MI60 (Bausch + Lomb). In the premium lens category, he chooses the Crystalens (Bausch + Lomb) or the TRULIGN (Bausch + Lomb). Multifocal lenses induce more aberrations than Dr. Jackson would like. However, some data suggest that the low-add Tecnis multifocal lens (Abbott Medical Optics, Abbott Park, Ill.) has similar halo rates to the monofocal counterparts in non post-refractive surgery eyes, he said. If he sees a post-refractive surgery cornea that multiple diagnostic devices tell him has mild aberration, he would consider trying a low-add multifocal IOL. Still, you have a risk of inducing more aberrations with this and other factors such as angle kappa to consider, he said. Cases with high angle kappa stand to cre- ate more aberrations since the visual and optical axis are not aligned together. Dr. Jackson prefers to use low-add multifocals in non post-re- fractive surgery patients with angle kappas less than 0.4. Dr. Shultz generally steers clear of multifocal lenses here. "In the past, I had tried to use multifocals in some of these patients, but I was very disappointed with the results," he said, adding that in order to even consider a patient for a multifocal lens after LASIK, they would have to have an extremely well-centered ablation, minimal to no higher-or- der aberrations from the cornea, an alpha angle measurement less than 0.45 mm, and typically a low diop- ter prior excimer correction that is in the order of no more than 2 to 3 D. Also, you must determine where the center of sight is relative to the center of the eye. "If you put a mul- tifocal lens in someone where you're not winding up over the line of sight after the capsule contracts, this is going to cause more aberrations," Dr. Shultz said. For that reason, in most patients he puts in a spherical- ly neutral Crystalens or TRULIGN toric IOL, which he also finds to be more forgiving for centration. Going forward, Dr. Jackson would like to see more options for this burgeoning population. He is looking forward to new lenses like the Tecnis Symfony extended range of vision IOL (Abbott Medical Optics) coming to the U.S. market in the near future. With this and other new technology in the pipeline, he is hopeful that already good results can become even better. EW Editors' note: Dr. Jackson has financial interests with Bausch + Lomb, Carl Zeiss Meditec, and Marco (Jacksonville, Fla.). Dr. Shultz has financial interests with Bausch + Lomb. Contact information Jackson: mjlaserdoc@msn.com Shultz: izapeyes@gmail.com FORWARD. Direction. Force. Momentum. 840 Walnut Street Philadelphia, PA 19107 www.willseye.org 1-877-AT-WILLS A world-class institution grows By doing the right things And moving all of us forward.

• Cover