Eyeworld

EW FEATURE 50 Presbyopia treatment • August 2016 AT A GLANCE • Setting expectations for visual outcomes from the get-go can impact patient satisfaction in the end. • Emphasize that the goal is functional vision with less dependence on spectacles, not necessarily perfect vision. • Addressing preop conditions, such as dry eye, prior to selecting and implementing a surgical treatment can result in better outcomes. by Liz Hillman EyeWorld Staff Writer If cataracts are not yet ad- vanced, Dr. Yeu said patients could try soft monovision contact lenses to confirm they would tolerate it as a permanent procedure, but in more advanced cataract patients, it would be more difficult to simulate the effect. "It can create some very polar- izing feelings among patients. It can create an imbalance, there can be a depth perception issue, and there certainly can be headaches that happen from trying to simulate monovision," Dr. Yeu said. "Some Dr. Trattler said he also wouldn't choose monovision for a patient who hadn't trialed it in contact lenses. Ideal candidates based on life- style, according to Dr. Yeu, are pas- tors, public speakers, teachers, and those in customer service. These are people who might have to switch quickly between looking down at notes and looking at an audience. Patients not as well suited for mono- vision cataract surgery are people who are required to read a lot during the day or do computer-based work, for example. "With any type of presbyopia- correcting surgery, setting expecta- tions is key. Patients want the vision they had when they were 25, but unfortunately, that's not possible," Dr. Schallhorn said. "Given the multitude of options, I also counsel patients that there is no right answer among the treatments we have. I tell patients that everyone is different, and the important part is finding a solution that works for them." Age can also be a factor. As William Trattler, MD, Center for Excellence in Eye Care, Miami, put it, younger patients who are less likely to have cataracts might have different surgical options avail- able to them compared to an older patient with cataracts and more advanced presbyopia. Monofocal cataract surgery Although monofocal cataract sur- gery patients might still be depen- dent on spectacles for close vision, Sumit "Sam" Garg, MD, associate professor of ophthalmology, Uni- versity of California, Irvine, and medical director, Gavin Herbert Eye Institute, said he tells them their vision will be much improved. For those with astigmatism, Dr. Yeu said she will sometimes use the Trulign Toric IOL (Bausch + Lomb, Bridgewa- ter, New Jersey). She added that the Softec HD (Lenstec, St. Petersburg, Florida) has been a good addition to her practice because it creates a little bit of depth of focus. "Instead of full-blown monovi- sion, this is an in-between," Dr. Yeu said. Monovision cataract surgery and LASIK Dr. Yeu said her happiest patients seeking surgical correction of presby- opia are monovision pseudophakes, provided they were already success- ful at adapting to monovision LASIK or with contact lenses. For patients who have not tried monovision, Dr. Yeu said it can be a difficult adjustment. "I shy away from full mono- vision in patients who have never done it before and depending on what their needs are," Dr. Yeu said. Setting patient expectations and achieving satisfaction is "sometimes the most difficult part" when it comes to presbyopia correction S urgical correction of presbyopia, reducing or eliminating dependence on glasses or contact lens- es, is like the "holy grail," as Elizabeth Yeu, MD, Virginia Eye Consultants, Norfolk, Virginia, described it. As intraocular and corneal op- tions for presbyopia correction come of age and continue to emerge in the market, choosing the right option and setting expectations to meet patient satisfaction for these elective procedures is key. "The management of expecta- tions is sometimes the most diffi- cult part," Dr. Yeu said. "There is anatomical success and then there is functional success. That is some- times the most difficult part of the patient experience process." Picking the procedure Julie Schallhorn, MD, assistant professor of clinical ophthalmology, University of California, San Francis- co, said her first step in recommend- ing a presbyopia-correcting proce- dure is to ask the patient what he or she expects his or her vision will be like after surgery. Challenge of managing patient expectations A multifocal IOL pre- and post-Verion (Alcon) alignment. This system provides a method to optimize outcomes for more satisfied patients. Source: Elizabeth Yeu, MD

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