OCT 2012

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

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92 EWINTERNATIONAL Panel continued from page 91 better to implant multifocals in patients who have an existing con- trast sensitivity deficit from their cataract. Also, I avoid multifocal implantation in patients who work in low-contrast situations, such as professional night drivers, cinephiles, radiology technicians, and pilots. Macular pathology and optic neuropathies that inherently diminish contrast sensitivity are im- portant contraindications. Dr. Soriano: My indications for mul- tifocal IOLs have diminished consid- erably. Initially, I was excited about the opportunity to correct pseudophakic presbyopia, but after seeing several patients dissatisfied with the visual quality obtained, my option remains monovision in some patients. As discussed above, the im- plant conditions for multifocal IOLs, despite being extended lately, must be restricted. It also should be taken into consideration the possible loss of visual potential that patients will present in the future because many will develop ARMD or diabetic mac- ulopathy, etc. Still, it's hard to know, even obeying the restrictions of use, which patients will adapt to having two images focused within the eye. Even explaining beforehand, many do not understand what to expect. Dr. Nosé: Exclusion criteria for me include patients who already had cataract surgery with monofocal lens implantation, irregular or abnormal corneas, severe dry eye, macular degeneration, advanced glaucoma, or any person with low visual poten- tial. Dr. Casanova: I am very satisfied with the results of diffractive multi- focal IOLs. Besides these reasons mentioned by my colleagues, I would like to include the personal profile: patients with high expecta- tions, extreme perfectionists, people requiring great night vision, or who have perfect near vision. I can remember some situations where I faced the perfect eye in the wrong patient. In one of them, a doctor with moderate hyperopia returned to my office four times to discuss a multifocal or aspherical monofocal IOL. He complained about some halos from the red indicator light while the TV was turned off. He was definitely not a good candidate. Also, I have reconsidered my indica- tion in an overweight patient who uses computers for many hours a day after having operated on a pa- tient successfully, revealing J1 as uncorrected near vision, but who Image is designed to represent nondescript visual impairment and is not intended to be medically accurate. For illustrative purposes only. © 2012 Santen Pharmaceutical Co., Ltd. All rights reserved. SAN-265.00 07/12 could not adjust the distance of the monitor as I had suggested due to her obesity. She was not able to approximate the table. Dr. Padilha: Do you have experience with accommodative intraocular lenses? Which IOL? If so, please give us the average of monofocal, multi- focal, and accommodative IOLs you implant on a monthly basis. If not, why don't you implant accommoda- tive IOLs at the present time? Are you planning to implant this kind of IOL in the near future? Dr. Soriano: Yes, [I have implanted] the old C&C AT45, which was the initial version of the Crystalens (Bausch + Lomb, Rochester, N.Y.) that basically did not change over time. Routinely, 100% of the lenses I use are monofocal. Considering the accommodative lenses, the problem is that the available lenses do not accommodate at all. There is no evidence that this happens. What confuses this is the pseudoaccom- modation that is present in any lens. I do not believe in the near future we will have a truly accommodating lens. Dr. Zacharias: I don't have experi- ence with accommodative IOLs, and I don't plan to implant them in the October 2012 Her eye disease.

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