Eyeworld

EW CATARACT 76 April 2017 Device focus by Rich Daly EyeWorld Contributing Writer EDOF targets The broader defocus curve on an EDOF IOL can be used in a few ways, Dr. Walton said. "Typically, I'll recommend the dominant eye first with an EDOF if the cornea is consistent across our four devices and we get good optical biometry data," Dr. Walton said. "This is in contrast with monofo- cals for which I tend to recommend non-dominant first at a slightly myopic target to increase the chance of hitting distance in the dominant without erring toward hyperopia." After the first eye, Dr. Walton re-evaluates the patient's functional status and if they are happy at all distances, he aims to replicate it in the second eye to preserve optimal depth perception. "If they want more near, we can use loose lenses over the first eye to simulate what the second will look like," Dr. Walton said. "Most patients will not need more than –0.5 D of myopia in the non-dom- inant eye to achieve an excellent result, and I typically aim closer to –0.35 D." "The difference is a subtle one between the ideal EDOF patient and the ideal multifocal patient, and that's the relative importance of distance versus near vision," Dr. Walton said. "I have found the EDOF lens to excel at distance even more than the latest multifocals. Even when EDOF patients test J1 or J2 in clinic, they occasionally state a preference for readers with pro- longed reading. The EDOF has been more forgiving of residual refractive error and low irregular astigmatism, and the release of the toric version plays a large role in the usefulness, too." Dr. Garg said EDOF recipients can still have some unwanted visual side effects but, so far, patients he has implanted tend to not complain as much about nighttime halo and glare compared to some multifocal recipients. "Therefore, I feel more com- fortable putting them in younger patients who lead active lifestyles," Dr. Garg said. "However, if I have an elderly patient who wants some independence from spectacles and really does not drive much at night, I may favor a low-add multifocal lens." now Johnson & Johnson Vision [J&J Vision, Santa Ana, California])," Dr. Garg said. Daniel Chang, MD, Empire Eye and Laser Center, Bakersfield, California, said his presbyopic IOL rate has probably doubled since the introduction of EDOF technology to about 30–40% of his total cases. "Some of that has grown from the toric monofocals that I was us- ing," Dr. Chang said. "Most patients with astigmatism correction are now receiving toric EDOF IOLs." Steven Dell, MD, Dell Laser Consultants, Austin, Texas, said mostly all his practice's toric IOLs are EDOF lenses at this point. "I still see a large role for multi- focal IOLs," Dr. Dell said. Patient selection Such broad use of EDOF technology stems from surgeons' views of the ideal recipients for such IOLs. Bennett Walton, MD, Slade & Baker Vision, Houston, said he views the ideal EDOF patient as someone who wants vision at multiple dis- tances, prioritizes distance over near, and who will not mind the optical effects of EDOF lenses. Surgeons shared what their experiences with EDOF lenses have taught them about patient selection, refractive targets, and mixing EDOF lenses with other types of IOLs S urgeons report an evolv- ing view of the best uses for extended depth-of- focus (EDOF) IOLs, based on their experience with them. Several surgeons say EDOF IOLs have become a significant share of the lenses they implant. For example, Sumit (Sam) Garg, MD, associate professor of ophthalmology and vice chair of clinical ophthalmology, University of California Irvine School of Medi- cine, said EDOF IOLs now comprise 15–20% of his lens recipients. "This is higher than my multifo- cal use, predominantly because I can now correct higher levels of astig- matism concurrently given the toric platform of the Symfony lens (for- merly Abbott Medical Optics [AMO], Where extended depth of focus IOLs fit Intraoperative appearance of ZLBOO (multifocal) vs. ZXROO (Symfony). Note the larger central zone and fewer number of rings. Source (all): Sam Garg, MD

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