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Reporting from the Date AAAA City, Country EW MEETING REPORTER 164 April 2016 On the other hand, a piggyback is something different entirely, Dr. Ayres said. It is done so that the second IOL makes up for the lack of power in the first. Piggyback IOLs are best for a low error in his opinion, ranging from about +/–4 D of residual refractive error. Never piggyback 2 acrylic IOLs, Dr. Ayres said, due to the fibrosis between the IOLs. He added that you can get chafe from the optic, so this is not a good option for small eyes. There are, however, many advantages to piggyback IOLs. There is minimal cost to the patient. For surgeons, there's no need to learn a new technique or worry about corneal indices, and with the ability to quickly adjust the refractive error, this is a good option for small to moderate myopic and hyperopic refractive errors. Surgeons may want to consider the possibility of using the laser as well. In conclusion, Dr. Ayres said that for a refractive surprise or prob- lem with an IOL in recent surgery, he would consider an IOL exchange. For refractive issues not addressed in the immediate postoperative period, a piggyback could be easier and less technically challenging. For refractive issues long after surgery, Dr. Ayres said to consider LASIK, PRK, or slit lamp AK. Additionally, recommending glasses or contacts is not necessarily the end of the world, especially if you're not comfortable with some of these procedures, he added. Roberto Pineda, MD, Bos- ton, highlighted PRK vs. LASIK for enhancement, and he spoke about which patients would be candidates for LVC enhancement. Over the last decade, accurate IOL power calculations have become a focal point of cataract surgery, he said. But even with the ability now to optimize individual components of IOL power calculations and to use advanced surgery techniques, it is still only possible to be within +/–0.5 D for better than 70% of surgeries and +/–1 D for better than 90% of surgeries, Dr. Pineda said. Additionally, he pointed out that about 10% of multifocal IOL Editors' note: Dr. Donnenfeld has financial interests with Abbott Medical Optics (Abbott Park, Illinois), AcuFocus (Irvine, California), Alcon (Fort Worth, Texas), and Bausch + Lomb (Bridgewa- ter, New Jersey). Dr. Yeu has financial interests with Abbott Medical Optics, Alcon, and i-Optics (The Hague, the Netherlands). Dr. Raviv has financial interests with Abbott Medical Optics, Alcon, and Glaukos (Laguna Hills, Cal- ifornia). Dr. Starr has financial interests with Alcon, Allergan (Dublin), Bausch + Lomb, Rapid Pathogen Screening (Sarasota, Florida), Shire (Lexington, Massachusetts), and TearLab (San Diego). Drs. Solomon and Tipperman have no financial interests related to their comments. Enhancements following cataract surgery Why would a surgeon need to do an IOL exchange or a piggyback IOL? Brandon Ayres, MD, Philadelphia, discussed this in his presentation. An IOL exchange may be nec- essary for a refractive surprise after cataract surgery, for malposition or function of the IOL, for a damaged IOL, when the patient is dissatisfied, or if it needs to be exchanged for an associated anterior segment surgery. Meanwhile, piggyback IOLs may be needed for a refractive surprise after cataract surgery, for a refractive en- hancement as a safer option than an IOL exchange, or for future sulcus lenses. Dr. Ayres offered a number of clinical pearls for those doing an IOL exchange because being able to do an IOL exchange is a must in advanced anterior segment surgery, he said. If you've mastered cataract removal with a lens implant, then you have the skills for a removal or exchange. Do not open the posterior capsule if you think a lens exchange will be necessary, he recommended. "Sooner is better," Dr. Ayres said. "It certainly is easier to do an IOL exchange if the surgery was in the last couple of months." He added a number of other helpful tips for the surgeon attempt- ing an IOL exchange. He stressed that the IOL can be cut and removed in pieces, and Dr. Ayres said he likes to do this so the pieces can be re- moved through a small incision. To make sure your optical dispensary is working efficiently, you need an experienced team. at's why the most successful practices turn to Partners In Vision. As a leader in Optical Dispensary Development + Management, we manage and grow your optical business through superior customer service, aention to detail, responsive inventory management and patient education. Let us be your team. Call for a free, no-risk assessment. PartnersInVision.com optical staffing • on-site presence • education • ar management managed care intgration • inventory control • marketing Since 1999 Do you really have the right team for the job? O P T I C A L D I S P E N S A R Y M A N A G E M E N T 888.748.1112

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