Eyeworld

EW CATARACT 34 July 2016 Pulse of ophthalmology: Survey of clinical practices and opinion by Mitchell Gossman, MD Reasons offered for preferring the manually loaded injector were: confidence folding is correct, prob- lems personally seen with pre-loaded injectors, ability to examine lens for flaws outside the eye, and never had problems with manual loading so no reason to switch. On the other hand, reasons for preferring the pre-loaded injector were that there is no exposure to the outside, therefore possibly less risk of endophthalmitis, it is faster, and there are no tech- or surgeon-induced scratches. The fourth question was, "Yel- low tint or clear in your eye? And why?" Reasons given for preferring the 1-piece were: better centration, sim- pler to implant, less traumatic to in- sert, and easier to exchange. For the 3-piece, reasons for the preference included: better centration (again), more predictable lens position, ver- satility of bag or sulcus placement, ability to easily capture optic, and ready ability to suture to sclera later if necessary. It occurred to me as I wrote this that I should have had plate haptic as a choice; however, no respondent offered this option. The third question was, "How would you implant the lens in your brother's eye? And why? [Not "your" eye, this is a preference more for the surgeon.]" an IOL implanted in your own eye, regardless of cost? And why?" Physicians respond to survey on what options they would choose for themselves or their family T here are a multitude of in- traocular lenses on the mar- ket. If 1 was far and away superior in terms of safety, features, cost, and perfor- mance, it would not take long for a few equally high performers to rise to the top. This does not happen, of course, because some of these attri- butes are mutually exclusive. There is no inexpensive multifocal lens, for example. So what IOL would we want in our own eyes? Is this necessarily the same as what we use in practice? Physicians do not have to perform procedures in accordance with their own personal desires. After all, who among us ophthalmologists who wears glasses hasn't been asked by a prospective LASIK patient why he hasn't had the procedure himself? Many of us perform procedures or employ devices we do not wish to have performed upon ourselves, but these are not necessarily hypocritical attitudes. Nevertheless, it is a fair question to ask a physician what he would do for a family member or himself. This article explores what intra- ocular lens implants are in use by North American ophthalmologists and why. A survey was performed of 97 practicing ophthalmologists who volunteered to participate from the ranks of participants of the eyeCONNECTIONS online community and volunteers in North America. Responses are anonymous in order to encourage candor. The first question was, "What optic material would you want in What intraocular lens would you want in your eyes? 1-piece 75% 3-piece 25% Manually loaded injector 71% Pre-loaded injector 29% Manual folding 0% Clear 86% Yellow 14% Reasons offered for clear were: more natural color vision, perceived association of yellow with glisten- ings, and remaining unconvinced of putative retinal protection benefit of yellow lens. Two colorful responses were "I want the vision I had when I was a kid" and "If I want sunglasses I will wear them." Reasons for yellow tint included: more natural color vision (again), retinal phototoxicity protection, and visibility better for loading and insertion. The fifth question was, "If any of the above answers differ from your actual practice, explain your reasons." Cost 29% Speed 0% Other 71% Specific responses given were: would use manual loading, but there are issues with techs; financial Factors contributing to the preference for conventional IOL emmetropia OU and wearing reading glasses were: best possible vision wanted for distance and don't mind wearing reading glasses, best stereopsis, fussy about vision quality, and concern about compromises of other solutions. Reasons for a conventional IOL with monovision were best distance and near with minimum compromise of vision quality. It should also be noted that 2 respondents said they would opt for moderate myopia OU. Com- ments about multifocals included multiple respondents expressing concern about halos, glare, loss of contrast sensitivity, and overall con- cern about vision quality. The main reason for preferring the Crystalens in general is a desire for some better near performance without the com- promises of multifocal optics. continued on page 36 Mitchell Gossman, MD Conventional IOL emmetropia OU and wear reading glasses 37% Conventional IOL with monovision 37% Multifocal 16% Crystalens, emmetropia OU 2% Crystalens, with a judicious amount of monovision "boost" 8% Hydrophobic acrylic 63% Silicone 19% Collamer 9% Hydrophilic acrylic 9% PMMA 0% Some of the reasons offered for acrylic included: less YAG pitting, more biocompatible, no issues if silicone oil is needed later on, less inflammatory reactivity, and less capsule opacification. Reasons for silicone included less positive dys- photopsia and long-lasting clarity. Meanwhile, reasons for collamer were that it has the best biocom- patibility and its immunity to YAG pitting. The second question was, "What IOL design do you prefer? And why?" penalization for not using bundled IOLs; and medical assistance fees make use of more expensive lenses unsustainable. The sixth question was, "Assum- ing no astigmatism, cost no factor, and considering all aspects such as vision quality, near quality, 'risk' of needing LVC after, and complication risk, what IOL regimen would you want in your own eyes? And why?"

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