Eyeworld

177 April 2017 EW MEETING REPORTER also need to be educated on the possible side effects, such as glare, halo, and the fact that they might have difficulty reading in low- light situations, for example. • Correct mindset. Not everyone is a good candidate for presbyopia correction, Dr. Ang said. Ophthal- mologists have to be a psycholo- gist to an extent—if the patient seems too demanding or is asking too many questions, they might not be a good candidate for these IOLs—in addition to considering pathology as well as physiolo- gy. After doing so, they need to match the lens to the patient needs and wants, he said. Dr. Ang also told his colleagues, don't sell yourself short when it comes to presbyopia-correcting IOLs. This is a premium technology, he said, and should be priced and valued as such. Multifocal IOL patient selection There are many multifocal IOLs on the market, but how to select the ap- propriate patient is key to achieving satisfaction, said Hungwon Tchah, MD, Seoul, South Korea, offering his five pearls. • Patient selection. These patients need to have the right person- ality, motivation, expectations, lifestyle and occupational needs, and financial situation. Fac- tors such as refractive error and previous ocular surgery need to be weighed as well. All in all, Dr. Tchah said extra chair time is needed with these patients to not only determine their candidacy for a multifocal IOL but to educate them on the potential adverse effects, including the possibility for postop refractive enhancement or IOL exchange. While he said there is no perfect candidate, there are a reasonable number of good candidates. • Pathology. A complete eye exam- ination needs to be conducted to identify any adverse pathology that could impact outcomes. This includes assessment of the tear film and meibomian glands, keratometry, topography, aber- rometry, retinal exam, IOP, and today. He recommended using either a manual or digital capsu- lorhexis template to achieve this. • Use digital marking to align the IOL. While marking the steep axis can be done with ink marks, Dr. Black said using a digital system can lead to better identification of the steep axis and IOL alignment. • Audit results. Auditing your results is "absolutely imperative," Dr. Black said. Auditing results in his practice showed Dr. Black that digital marking was superior to ink marking, and it helped with understanding surgically induced astigmatism. Managing presbyopia with IOLs Correcting presbyopia with IOLs can be tricky, stressful, and time-con- suming, said Robert Ang, MD, Manila, Philippines. Yet ultimately, when the patient is pleased with the outcome, it's very rewarding. Dr. Ang offered five pearls for achieving patient satisfaction with presby- opia-correcting IOLs. • IOL targeting. Dr. Ang said using an optical biometer and keratom- eter or IOLMaster (Carl Zeiss Med- itec, Jena, Germany); engaging advanced calculators, such as the Barrett or the Haigis; personalizing your A-constant; and using a toric IOL for 1 D or more of cylinder can better target your IOL choice. • Check for pathologies. In eyes with 20/30 best distance visual acuity, be suspicious, Dr. Ang said. He recommended measuring best potential vision using a dilated vi- sion test or potential acuity meter. He also said a dilated retina exam is a "must," and recommended using OCT to check for epiretinal membrane, macular edema, and glaucoma. When in doubt, switch to a monofocal IOL, Dr. Ang advised. • Know the latest technologies. "You have to expose yourself and learn as much about new technologies as possible," Dr. Ang said, men- tioning trifocal and extended depth-of-focus IOLs. • Manage expectations. Do not over- promise, Dr. Ang cautioned. Use words like "less spectacles," rather than "no more" glasses, he said. With multifocals, he said patients continued on page 178

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