Eyeworld

2 2 The impact of refractive error on outcomes and patient satisfaction limit that most patients can toler- ate, a monovision target of –1.50 to –1.75 D is more commonly used to minimize the visual compromises. This range provides good intermediate vision but will typically not provide sufficient near vision for pseudophakes or for phakic patients in their 50s and beyond. Corneal inlays are implanted monocularly but may in some cases offer a different fundamen- tal mechanism for reestablishing near visual acuity. The small aperture inlay, for example, relies on pinhole optics to extend the depth of focus and provide near acuity. Unlike monovision, which requires patients to suppress distance vision when reading near, there is no need to suppress distance because it remains in focus. Patients with small aper- ture inlays are binocular under all conditions except near focus. Presbyopia-correcting IOLs When performing refractive lens surgery with a multifocal IOL, a plano target is ideal. The current standard has been to achieve results within ±0.5 D of a plano correction. However, many practices are now reporting even tighter refractive accuracy, within ±0.25 D, thanks to improvements in technology to measure axial length and formulas used to cal- culate IOL powers. Patients with better uncor- rected acuity are more satisfied with their outcomes. Satisfaction drops significantly if patients have more than 0.5 D of error in either direction. Patients who are 0.5 D hyperopic are significantly less satisfied than those who are 0.5 D myopic. Newer, low add multifocal IOLs, extended depth of focus IOLs, and extended range of vision IOLs may benefit from a slightly myopic micro-monovi- sion target in the nondominant eye and may also prove to be more tolerant of minor amounts of residual refractive error. Dr. Vukich practices with Dean Medical Center in Madison, Wisconsin. He can be contacted at javukich@gmail.com. continued from page 1 Figure 1. In U.S. commercial implantations of the KAMRA small aperture inlay (AcuFocus), the best near and distance vision results were achieved when the MRSE was –0.25 D or more myopic. Figure 2. The most satisfied patients achieved good UCNVA and UCDVA (20/25 or better) in the inlay eye. De- cline in near vision resulted in a bigger reduction in satisfaction than decline in distance vision.

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