Eyeworld

World view Renaissance for presbyopia W hile the last decade may be seen as the "Era of refractive cataract surgery," a proliferation of new technologies and approaches are poised to make the next decade the "Renaissance period for presbyopia." With the recent explosion of new options for surgeons to offer motivated patients, the ability to customize treatment plans to each patient's stage in life and visual lifestyle dramatically increases. But the risk of overwhelming a patient with new options and terminology also increases. Now more than ever before, surgeons have a deep obligation to understand the nuances of these technologies, in- cluding their ideal inclusion and exclusion criteria, in order to enable a clear, confident, and customized recommendation to their patients. In this issue of EyeWorld, experts review these new approaches, offer advice on patient selection, and help us navigate these new waters with pearls to avoid pitfalls and attain excellent results. Daniel Durrie, MD, and George Waring, MD, who introduced us to the concept of dysfunctional lens syndrome (DLS), lay out a staging paradigm for DLS that gives surgeons an easy way to match patients to a customized visual solution at any stage of life. Using patient age and technologies to quantify optical scatter index, wavefront analysis, and lens densitometry, surgeons can more confidently present options and make clear recommendations. Elizabeth Yeu, MD, William Trattler, MD, Sumit Garg, MD, and Julie Schallhorn, MD, offer their advice on screening and evaluating patients for eligibility for presbyopia procedures. These experts discuss a screening process to identify pre-existing pathology that might affect eligibility and/or outcomes with various presbyopia procedures, and strategies for managing patients with suboptimal outcomes. John Berdahl, MD, Kendall Donaldson, MD, and Audrey Talley- Rostov, MD, brilliantly explain a philosophy of "starting with a plan to finish" that embodies our commitment to achieving excellent outcomes for every single patient, utilizing any and all means necessary. They offer tips on choosing the right presbyopia-correcting IOL for individual patient needs, as well as assessing anatomical and psychological candidacy. Finally, Preeya Gupta, MD, and Sumit Garg, MD, give us a comprehen- sive overview of exciting new technologies and approaches to presbyopia that move us beyond the limitations of the old presbyopia options of mono- vision LASIK/PRK or high-add multifocal IOLs. These leaders review the newly FDA-approved corneal inlays KAMRA and Raindrop and their unique applications and mechanism of action. Looking ahead, we get a preview of technologies on the horizon such as the Presbia Flexivue Microlens, FluidVision accommodating lens, the Tecnis Symfony IOL, the Light Adjust- able Lens, and groundbreaking pharmacologic therapies for presbyopia. We may not have da Vinci, Michelangelo, Botticelli, Galileo, or Copernicus among us, but I hope you enjoy as much as I do the insights of our own Renaissance contemporaries in this issue of EyeWorld. EW Neel Desai, MD Refractive Editorial Board member The official publication of the American Society of Cataract & Refractive Surgery A S C R S August 2016 Volume 21 • No. 8 Publisher Donald R. Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Michelle Dalton Reading, Pennsylvania Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Paul Zelin paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. Advertising Offices: ASCRSMedia, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. 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