SEP 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 64 of 103

September 2012 Refractive cataract surgery February 2011 EW FEATURE 65 director, UCLA Laser Refractive Center, Jules Stein Eye Institute, Los Angeles, shared the experience of a 76-year-old female patient with am- blyopia in the left eye who wanted spectacle independence. Her cylin- der was 0.75. In her right eye, she had minimal corneal cylinder and nuclear sclerosis that was consistent with her vision in that eye, which was 20/50. Her retinas were clear. The challenge with this case was deciding which eye to operate on first and deciding whether or not to try monovision, an option Dr. Hamilton decided not to use. Dr. Hamilton chose to operate first on the amblyopic eye. "I think most of the time, the patient wants the amblyopic eye done first, and that's what happened here," he said. He implanted a Tecnis monofocal (Abbott Medical Optics, AMO, Santa Ana, Calif.) in that eye and a multi- focal lens in the dominant eye. The patient was pleased with the results. Trying a multifocal IOL in one eye Dr. Hamilton then presented the case of a 71-year-old man who wanted spectacle independence and had never used monovision contact lenses. He had some asymmetrical astigmatism, more in the right eye than in the left. His cataract was worse in the right eye. He had previous pterygium incisions, and his topography looked normal. His Poll size: 329 Source: Sonia H. Yoo, M.D. with-the-rule astigmatism was 2.4 in the right eye and slightly less in the left eye. "I did a toric IOL in the right eye. He ended up doing well but wanted spectacle independence," Dr. Hamilton said. So in the left eye, he implanted a multifocal IOL and performed astigmatic keratotomy. However, 1 month later, the patient hated his left eye vision. He said he could read the newspaper only if he closed his left eye. "He was adamant that he wanted the lens out," he said. The patient even called the lens manufacturer with some questions about whether or not the lens was defective. "We did an IOL exchange with a monofocal toric IOL, and the patient was 20/15 at post-op day 1," Dr. Hamilton said. "The patient said, 'You gave me my life back.'" A unique circumstance with this case was the patient's unusual depth of field, which can yield unexpected near visual acuity, Dr. Hamilton said. Dr. Hamilton concluded that a unilateral multifocal IOL may have lower acceptance if the patient is comparing vision with the outstanding fellow eye. EW Editors' note: Dr. Hamilton has finan- cial interests with Alcon (Fort Worth, Texas), AMO, Reichert (Depew, N.Y.), and Ziemer (Port, Switzerland). Dr. Yoo has financial interests with Alcon, Allergan (Irvine, Calif.), Bausch + Lomb (Rochester, N.Y.), and other ophthalmic companies. Contact information Hamilton: 310-825-2737, Hamilton@jsei.ucla.edu Yoo: 305-326-6322, syoo@med.miami.edu EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send a 4-6 question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email daniela@eyeworld.org and put EW Pulse in the subject line; that's all it takes. Copyright EyeWorld 2012

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