Eyeworld

The impact of refractive error on outcomes and patient satisfaction: Data-driven pathways to target outcomes and reduce refractive surprises Presbyopia 365 Curriculum continued on page 2 Supported by Abbott Medical Optics Inc., Alcon Laboratories Inc., and AcuFocus This monograph is part of a year-long curriculum focused on treatment of presbyopia and management. Accreditation Statement This activity has been planned and implement- ed in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract & Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accred- ited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this activity will: • Implement a lower threshold for acceptable pseudophakic refractive errors in presbyopia- corrected patients • Identify steps to mitigate refractive surprises and other key variables to increase postopera- tive success Designation Statement The American Society of Cataract & Refractive Surgery designates this enduring materials educational activity for a maximum of 1.0 AMA PRA Category 1 Credits. ™ Physicians should only claim credit commensurate with the extent of their participation in the activity. Claiming Credit To claim credit, participants may visit bit.ly/28QBtJM to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this monograph may be faxed to the number indicat- ed for credit to be awarded, and a certificate will be mailed within 2 weeks. When viewing online or downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through December 31, 2016. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs. org or 703-591-2220. Financial Interest Disclosures Steven Dell, MD, has an investment interest in and has received a retainer, ad hoc fees, or other consulting income from: Presbyopia Therapies and Tracey Technologies. He has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Advanced Tear Di- agnostics, Bausch + Lomb, Lumenis, and Optical Express. Douglas Koch, MD, has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Alcon Laboratories Inc., Clarity Medical System, Ivantis Inc., Perfect Lens LLC, PowerVision Inc., and ReVision Optics Inc. He has received research funding from: i-Optics, TrueVision Systems Inc., and Ziemer Inc. Richard Tipperman, MD, has no ophthalmic- related financial interests. John Vukich, MD, has received a retainer, ad hoc fees, or other consulting income and is a member of the speakers bureau of AcuFocus Inc. Elizabeth Yeu, MD, has an investment interest in Modernizing Medicine and Strathspey Crown LLC. She has an investment interest in and has received a retainer, ad hoc fees, or other con- sulting income from RPS. Dr. Yeu has received a retainer, ad hoc fees, or other consulting income from and is a member of the speakers bureau of: Abbott Medical Optics, Alcon Laboratories Inc., Allergan, Bio-Tissue Inc., Ocular Therapeutix Inc., Shire, TearLab, and Valeant. She has received a retainer, ad hoc fees, or other consulting income from Alphaeon, GlassesOff, and TearScience. Dr. Yeu is a member of the speakers bureau of Omeros Corporation. Staff members: Laura Johnson has no oph- thalmic-related financial interests. Jan Beiting has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, AcuFocus, Allegro Ophthalmics, Imprimis Phar- maceuticals, Johnson & Johnson Vision Care, and STAAR. satisfaction drops off dramatically (Figure 2). This mirrors what we have seen in previous studies of patient satisfaction with multifo- cal IOLs as well. Surgical monovision Monovision results in a loss of binocularity, depth perception, and image summation and may not be tolerated by some patients. Although –2.0 D is the practical Targeting inlay outcomes It is recommended, for example, that the small aperture corneal inlay be implanted monocularly in an eye with –0.75 D myopia (and a plano fellow eye). This re- fractive target can provide a depth of focus of up to 2.75 D and near visual acuity of J1 or better. A plano to hyperopic refraction in an eye implanted with this style of inlay will result in poorer near and distance vision (Figure 1). As visual acuity—and especial- ly near acuity—decline, patient power. This concept now has expanded to include pseudopha- kic loss of near vision with implantation of distance-correct- ed monofocal intraocular lenses (IOLs). To effectively take presbyopia correction to new levels, we need to examine how we can use the latest technology to correct a pa- tient's refractive error and restore uncorrected vision at all ranges. The options for correcting presbyopia include progressive or bifocal spectacles; multifocal contact lenses; monovision with contact lenses, LASIK, or IOLs; cor- neal inlays; and presbyopia- cor- recting IOLs. Specific visual needs and preferences, ocular anatomy, concomitant disease, and other factors must be taken into con- sideration in determining which approach is best suited for a given patient. When pursuing any surgical solution to presbyopia, refractive targeting must be precise. The ideal refractive target may be a slightly myopic or hyperopic one, rather than plano. Advances in technology and techniques are making new refractive outcomes possible T raditionally, ophthalmol- ogists have considered presbyopia to be an age-related alteration in the ability of the hu- man lens to change its refractive by John Vukich, MD Today's options and opportunities: What is the "new bar" for presbyopia correction? John Vukich, MD " Satisfaction drops significantly if patients have more than 0.5 D of error in either direction. " –John Vukich, MD EyeWorld July 2016 Click to read and claim CME credit

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