EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/82503
66 EW SECONDARY FEATURE February 2011 Premium IOLs September 2012 Time to make a switch by Jena Passut EyeWorld Editor Indications, pearls offered for multifocal IOL exchange T here are papers, seminars, symposia, and articles devoted to unhappy multi- focal patients—how to avoid them by careful patient selection, how to deal with them in the office, and how to maintain your cool when they become unbearably dissatisfied and demanding. When waiting, neuroadapta- tion, and referring them out don't work, exchanging the multifocal lens may become a necessity. EyeWorld spoke to three surgeons about timing a multifocal exchange and what techniques may make the process easier. "We should strive to never have to exchange anyone for any reason," said Richard Tipperman, M.D., Wills Eye Hospital, Philadelphia. "The flip side is that it's not fair to take a patient who says, 'My vision is not satisfactory. I don't want to see like this for the rest of my life,' and tell him, 'You've gotta live with it.'" Dr. Tipperman believes that a change of mindset needs to take place about MFIOL exchanges, one that considers the refractive bonuses of cataract surgery and premium lenses. "For obvious reasons, no one wants to have to do an implant exchange for any patient, but the flip side is that advanced technology IOLs are a refractive procedure," Dr. Tipperman said. "The ability to ex- change the lens turns it into a 100% completely reversible refractive pro- cedure. There are no other surgical refractive procedures that are com- pletely reversible. Less than 1-2% of patients who are implanted are un- happy, but it's a real phenomenon." Multifocal in place at start of case Haptic is stuck so has to be cut to remove optic from bag. Haptic can be dissected out later or, as in this case, simply left behind where it causes no problem Indications for MFIOL exchange Cathleen M. McCabe, M.D., partner and medical director, The Eye Asso- ciates, Sarasota, Fla., said an IOL exchange can be avoided at first by performing "meticulous pre-opera- tive measurements and patient selection, with special emphasis on setting realistic expectations by fully disclosing the unique benefits and risks, strengths and weaknesses of each lens design." Even so, patients may become intolerant of glare and halos and their inability to read or focus in the intermediate range. They also might be experiencing changes in the over- all health of the eye, such as optic nerve damage or corneal disease. "It is often difficult to determine if the reason for a patient's dissatis- Wavefront Optimized RefraXion The OPD-Scan III Wavefront system maps a patient's total visual system by projecting 2520 data points of light and harvesting a total of 23 diagnostic metrics in just 20 seconds. This data is instantly transferred to the digital refractor where a majority of patients will only require a 20-30 second refinement. Acuity and comparison to glasses is virtually instantaneous. Graphic depiction of OPD-Scan III light transmission of 2520 real data points across a 9.5mm pupil Most patients, as selected by OPD-Scan III, will exhibit a "clean" optical system and can be quickly verified/refined with the digital refractor. Others may require a more traditional full refraction. NOW, the OPD-Scan III shows you and the patient a clear depiction of their optical system. The TRS-5100 then completes basic refinements or traditional, full refractions (HOAs, pathologies, Rx shifts from central-4mm), and patients can compare old vs. new Rx.