Eyeworld

EW CATARACT 72 January 2017 distance VA was 6/9 in 84% of patients, uncorrected intermediate VA was 6/9 in 86%, "but uncorrected near VA of J2 and better was record- ed in 44% only," he said. The better visual outcomes and similar side effects are propelling patient prefer- ence, Dr. Assia said. Dr. Kanellopoulos said he'd been "discouraged initially" with multifocal lenses because of the contrast sensitivity issue in high scotopic and mesopic conditions and the inability to function with intermediate vision. But he's a firm advocate for trifocal lenses. "They appear to be an extremely good solution for a significant num- ber of patients who require or would benefit from spectacle independence due to lifestyle or preference," Dr. Kanellopoulos said. Patient selection pearls Patient selection was deemed a cru- cial aspect when considering multi- focal or accommodative lenses, but those kinds of strict criteria "usually applies to technologies that are not intended for mass adoption," Dr. Kanellopoulos said. "In my hands, trifocal lenses are a product that could be offered to almost every pa- tient with minimal disadvantages." Dr. Mertens recommends surgeons apply the same caution in a potential trifocal patient as they would a multifocal patient. "This includes a thorough anamnesis with the lifestyle of the patient, determining his/her expec- tations and motivation—all of these are still key to success," he said. As with any refractive cataract patient, he also advises checking for dry eye or corneal issues. Treating the ocular surface before surgery is necessary regardless of the type of lens, but may be even more important with enhanced technologies. "Are there retinal problems such as drusen or diabetes? In the latter case, this is a relative contra- indication and should be discussed in depth with the patient," he said. "The higher the patient satisfaction, the better ambassadors they'll be for your practice." For Dr. Assia, patient selection, indications, and contraindications for trifocals are generally similar to bifocals, however, "since clinical results are superior, the selection criteria for trifocals is slightly more liberal than bifocal lenses." Dr. Cummings will "routinely" perform a multifocal contact lens trial on potential candidates, and "if patients like the contact lens trial, I am confident that they will like the trifocal IOL—especially if they have stated that their intermediate vision is much more important than their near vision." From a surgical standpoint, he recommends surgeons ensure that pupils are mobile and "not tonic and miotic." While these lenses are still in their infancy, they seem to be on the verge of overcoming most patient complaints with other high technol- ogy lenses. "I think the future will surprise most clinicians in the trifocals' ease of use and their potential advantages in enhancing and transforming cat- aract surgery into a supreme refrac- tive surgical procedure with superior outcomes," Dr. Cummings said. EW Editors' note: Dr. Cummings has finan- cial interests with Alcon. Dr. Mertens has financial interests with PhysIOL. Drs. Assia and Kanellopoulos have no financial interests related to their comments. Contact information Assia: assia@netvision.net.il Cummings: abc@wellingtonclinic.com Kanellopoulos: ajkmd@mac.com Mertens: e.mertens@medipolis.be Trifocals continued from page 70 www.physiol.eu Beyond the limits of vision Already 200 000 FineVision lenses made your patients happy. Thank you for your trust. FineVision, the first trifocal diffractive IOL 200 000

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