JAN 2016

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 29 of 78

EW CATARACT 27 A NEW ERA IN STERILE CORNEA ALLOGRAFTS EASY-PEEL PACKAGING Patented easy-peel packaging allows for quick introduction of sterile tissues to the surgical field, saving valuable OR time. 99.9% CLARITY Unlike traditional patches, Halo corneas are clear and will remain clear, resulting in simplified post-op assessment and improved patient cosmesis. STABLE STORAGE Halo tissues can remain at room temperature and never need reconstitution, so you'll always be ready for emergencies as well as scheduled procedures. Developed at Lions VisionGift's renowned Vision Research Laboratory, Halo sterile tissues provide surgeons with distinct procedural and cosmetic benefits. © Copyright 2015 Lions VisionGift and Stephens Instruments ( 800 ) 354-7848 stephensinst.com halo@stephensinst.com Distributed exclusively through For more information visit halograft.org by Michelle Dalton EyeWorld Contributing Writer Cataract surgery in eyes with compromised corneas acceptable amount of multifocality, then I might consider a multifocal lens." However, if the RMS value cannot be dropped to under 0.2, "then you don't want to add addi- tional multifocality to the eye, and I would consider a Crystalens [Bausch + Lomb, Bridgewater, N.J.] because its optic is an aspheric monofocal." Multifocal lenses "will am- plify any abnormalities of the cornea," said Uday Devgan, MD, founder, Devgan Eye Surgery, Los Angeles, chief of ophthalmology, Olive View-University of California Los Angeles (UCLA), and clinical professor of ophthalmology, UCLA. "I think multifocal lenses should always be used with caution, even with perfectly normal eyes, but you should be very careful of an eye that has any kind of irregular ocular surface." Dr. Silverstein will consider performing a superficial keratectomy with mitomycin-C to help reduce risk of a central recurrence in those with EBMD, but agrees that the po- tential visual outcome after cataract surgery is what drives his recom- mendations. "We may get a refractive change as a result of the keratectomy, and that needs to be considered in the IOL calculations," he said. "If the pa- tient has a good central clearing and the rest of the cornea is healthy, ad- vanced implants can be considered." But in cases of significant Fuchs' dystrophy with 3+ guttae or more, who do not need grafts right now, "I do not recommend a premium lens implant because it's more likely than not that they will require a DSEK and that will change their refrac- tive outcome," Dr. Silverstein said. Although a pseudoaccommodating lens might be an option, "they may not get the true value of the lens implant long term, since they will progress." Dr. Devgan is more conservative —even if the patient's underlying condition is treated, surgeons have to ask if the surface is going to re- main healthy or if there is a progres- sive disease. "If there's Fuchs,' in 5 years the corneal endothelium is going to look worse than it does today," he said. "A toric lens could be For patients with an unhealthy cornea, cataract surgery options are more limited T here are numerous causes behind an unhealthy cor- nea—Fuchs' dystrophy and dry eye, among others—but couple the corneal disease with visually significant cataract, and patients' options are more limited than if the cornea had been healthy. Even after treating the cor- neal problem, these patients often do not achieve the level of visual re- covery that people without corneal disorders do. Experts say be cautious with these patients, and expect to spend more time with them. "A basic rule of thumb, with few exceptions, is that if the patient has a significantly compromised cornea, don't consider multifocals," said Marguerite B. McDonald, MD, Ophthalmic Consultants of Long Island, because to truly appreciate the benefit of a multifocal lens, the eye has to have "exquisitely perfect optics." Younger patients with very mild dry eye that can be medically controlled may be an exception, but those with even the mildest form of Fuchs' today are probably going to need corneal surgery down the road, and Dr. McDonald would argue against a multifocal lens. Patients with any type of corneal dystrophy or abnormality should be considered for a pseudo- accommodating lens rather than multifocal IOLs because of "the additional issues of contrast sensitiv- ity diminution, which are caused by the multifocal. Even if a superficial keratectomy is performed for epi- thelial basement membrane dystro- phy (EBMD), there is a significant percentage of patients in whom this condition recurs," said Steven M. Silverstein, MD, founder, Silverstein Eye Centers, Kansas City, Mo. Vance Thompson, MD, found- er, Vance Thompson Vision, Sioux Falls, S.D., thinks the issue may not be so clear-cut. "First analyze if it is an anterior, central, or posterior cor- neal issue. Can it be easily addressed with corneal scraping or a PTK? If we can take that irregularity or multifocality and remove it to make more of a monofocal cornea or an continued on page 28

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