Eyeworld

EW CATARACT 28 by Rich Daly EyeWorld Contributing Writer of the paper. Patients assess the number of vertical paper lengths at which they typically hold reading materials from their eyes. "The average in our practice is approximately 1.5 paper lengths, which corresponds to 16.5 inches," Dr. Dell said. "This test has been per- formed on several hundred patients in our practice, and we have validat- ed its function." Practices can use a tablet-based or laptop-based version of the ques- tionnaire with a calibrated piece of string to determine reading distance. The updated questionnaire also mentions the possibility of starbursts and halos to accurately describe possible dysphotopsias from EDOF lenses. Questionnaire impacts Dr. Dell has found his questionnaire quickly provides good information difficult choices and to determine how willing they would be to make optical compromises," Dr. Dell said. Initially designed to expedite patient flow amid the advent of presbyopia-correcting IOLs, the questionnaire quickly assesses inter- est in presbyopia correction while simultaneously educating patients about various treatment options. The questionnaire became widely used and has been translated into multiple languages. A new version of the question- naire, which includes assessments of the latest available IOL options and digital reading devices, has added a self-test to determine habitual read- ing distance. The self-test utilizes a printed version of the questionnaire on a standard 8.5- × 11-inch sheet of paper, and roughly assesses reading distance by using the vertical length Carefully constructed questionnaires can help surgeons connect clinical options to patients' needs and desires T he goal of high patient visual satisfaction is more attainable than ever due to a growing variety of IOL options. But more options have also increased the need for ef- fective communication tools to find the best match. "The answer to the question of which patients do best with which IOL has become much more com- plex as our available options for IOLs have expanded," said Steven Dell, MD, medical director, Dell Laser Consultants, Austin, Texas. Among the growing number of IOL options are multifocal IOLs with a variety of near add powers with and without astigmatic correc- tion, accommodating IOLs with and without astigmatic correction, and Cataract editor's corner of the world One way to match IOLs to patients' visual goals T his month's "Cataract editor's corner of the world" focuses on a very important aspect of patient care: patient/physician communication and matching patient needs and expectations with IOL choices and outcomes. In this article, Steven Dell, MD, and I discuss assessing patients' best IOL choices by talking to them about their desires for vi- sual performance and expected outcomes. Dr. Dell first developed the Dell Patient Questionnaire in 2004 to help physicians better understand patient expectations and requirements. He has since gone on to refine it, and there are also other tools available to help us ascertain which IOL would best suit patients' needs. It is always important to first establish that there are not any anatomical contraindications to implanting certain IOLs, but it is equally as important to listen to patients and help determine if one IOL may suit them better than others. Rosa Braga-Mele, MD, MEd, FRCSC, Cataract editor an entirely new category of extend- ed depth of focus (EDOF) IOLs with and without astigmatic correction. Many surgeons blend these technol- ogies, with different IOLs placed in the right and the left eye. Surgeons may also use a small amount of defocus in one eye to expand the functional range of near vision. "With all of these options, the choice of which IOL is best for patients depends a lot upon their current visual situation as well as their visual goals after surgery," Dr. Dell said. "Quickly and accurately assessing these goals is important in achieving high degrees of patient satisfaction." Reading key One important assessment involves determining a patient's habitual reading distance, according to Rosa Braga-Mele, MD, professor of oph- thalmology, University of Toronto. "Different IOLs address different reading distances," Dr. Braga-Mele said. "Higher add multifocal IOLs (MFIOLs) are better at 35 to 40 cm, and lower add MFIOLs or EDOF IOLs are better at 45 to 48 cm reading distances. It depends on what the patient wants." Additionally, it is important to determine which eye is dominant. Matching IOL options to patients' habitual reading distance has become more important amid the proliferation of reading formats, including physical books, tablets or e-readers, and laptops or desktops. "All of these options involve different working distances, which requires a tailored approach to se- lecting an appropriate IOL solution," Dr. Dell said. He noted that patients with short arms will typically read at a significantly different working distance than a tall patient with very long arms. Equally important is the pa- tient's current refractive error. "A 2 D myope who removes glasses to read will be highly at- tached to his or her current working distance," Dr. Dell said. Questionnaires help In 2004, Dr. Dell's practice launched a questionnaire to assess patients' visual function goals. "The questionnaire was de- signed to force patients to make The latest version of the Dell Cataract and Refractive Lens Exchange Questionnaire has several changes from an earlier version, including the addition of a self-test to determine habitual reading distance. Source: Steven Dell, MD June 2017

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