EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/87458
October 2012 EWINTERNATIONAL 91 Panel in Brazil discusses premium lenses Participants Dr. Padilha: In your personal experi- ence, with what kinds of premium IOLs have you accomplished the best results? Dr. Zacharias: A premium IOL is a relative concept and can offer something more than correcting the spherical refractive error. Nowadays, I'm having good results with both toric and multifocal diffractive IOLs. Miguel Â. Padilha, M.D., is director, Brazilian College of Surgeons, and director, MPOftalmo – Excelência em Oftalmologia, Rio de Janeiro Fábio Casanova, M.D., completed his residency and Ph.D. at Federal University of São Paulo, São Paulo, and his post-doctorate at Harvard University Dr. Ghanem: I agree with Dr. Zacharias' comments. My best results are with total diffractive and diffractive/refractive multifocal IOLs, toric IOLs, and the combination of both technologies. Ramon Ghanem, M.D., director, Cornea and Refractive Surgery Department, Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil Walton Nosé, M.D., is professor, Federal University of São Paulo Dr. Soriano: Personally, I do not like the term "premium." It carries a strong connotation of marketing, implying that the patient will receive a "plus" or a "prize." This devalues conventional lenses, which are ideal for most occasions. In my view, it is important that physicians and patients understand that there are different types of lenses and the choice can be somewhat cus- tomized. The lenses that I have the best results with are the toric ones. Eduardo Soriano, M.D., is staff member, Cataract Service, Federal University of São Paulo Fernando Trindade, M.D., is director, Cançado-Trindade Eye Institute, Belo Horizonte, Minas Gerais, Brazil Dr. Casanova: For me, premium IOLs represent an evolution in technology. We have noticed this progress in the last 10-20 years. Over time, the new technology becomes the standard. We expect cheaper and higher quality products in all customer segments, and this is not different for the IOL market. I have excellent results with both diffrac- tive multifocal and toric IOLs, as well as a combination of both technologies. Dr. Padilha: What situations do not indicate multifocal lenses? Explain the reasons for not implanting refractive or diffractive lenses in patients who come to your office asking for them. Dr. Zacharias: The candidate for a multifocal IOL needs to fill some basic requirements—having a normal ophthalmic examination, a good corneal surface, regular astig- matism, a normal retina examina- tion, and a normal optic nerve with good visual potential. Furthermore, the patient needs to understand the way the lens works and the limita- tions it has, such as halos at night, reduced contrast sensitivity with difficulty to read in dim light, and poor performance at intermediate distance. Some patients are not can- didates for a multifocal despite their desire to have one. Dr. Ghanem: Patients who have impairment of visual acuity due to systemic or ocular pathology with the exception of lens opacity are not good candidates. Most common causes for not indicating multifocal IOLs in my office include macular problems (age-related macular degeneration and epiretinal membranes) and corneal disorders (moderate and severe dry eye and irregular astigmatism). Dr. Trindade: As we all know, multi- focal IOL implantation should ide- ally be done in normal eyes. So a common pathology such as dry eye, glaucoma, macular degeneration, or cases of previous refractive surgery should be carefully analyzed before indicating a multifocal. With regard to refractive lens exchange, I never indicate multifocal implantation for emmetropic presbyopes. Because of contrast sensitivity reduction it is continued on page 92 Premium IOLs represent an evolution in technology. We have noticed this progress in the last 10-20 years. Over time, the new Wagner Zacharias, M.D., is director, Centro de Cirurgia Ocular Jardins, São Paulo technology becomes the standard Fábio Casanova, M.D.