Eyeworld

EW CATARACT 40 October 2017 Cataract editor's corner of the world by Rich Daly EyeWorld Contributing Writer absolute contraindications to use of these lenses. Dr. Yeu has used the lenses in patients in their 70s or 80s with mild 1+ guttata. "I know they are not going down the road of an advancing Fuchs' dystrophy, and patients have done well," Dr. Yeu said. However, Dr. Yeu warned sur- geons new to the lenses to begin with "relatively to quite healthy eyes." Those can include patients with astigmatism within 2.5 D because presbyopia-correcting lenses can now address that. Patient education When patients strongly desire spec- tacle independence but don't have a pristine eye, Dr. Berdahl explains that it may become necessary to ex- plant the lens in the future so they should not have a capsulotomy. "You need to give yourself the ability to retreat from the path that you are on with an explant if you are pushing the limits of the lens technology," Dr. Berdahl said. In addition to significant discus- sion through the informed consent process, Dr. Donnenfeld often has a bit and have found significant success with the use of EDOF lenses in those instances that I would not have considered a multifocal im- plant in the past," Dr. Yeu said. John Berdahl, MD, Sioux Falls, South Dakota, avoids implanting the lenses in patients who still want to wear glasses, and is cautious in those with irregular astigmatism, exces- sive dryness, retinal pathology, or glaucoma. "We are pushing the limits with these technologies because they are more robust than ever but we need to educate patients carefully that a lens may not work well in a non-pristine eye," Dr. Berdahl said. Dr. Donnenfeld's evaluation includes looking for a good tear film. All patients who are candidates for cataract surgery should have an evaluation of their ocular surface, looking for signs of dry eye or signif- icant issues, he said. Another focus is the macula, specifically the epiretinal mem- branes and any signs of macular drusen. Dr. Donnenfeld considers mild corneal or retinal disease to be a relative contraindication, while severe corneal and retinal disease are Surgeons identify the best patients for the latest advances in multifocal and extended depth of focus technologies T he availability of multifocal IOLs (MFIOLs) and extend- ed depth of focus (EDOF) IOLs in the higher and low- er add powers has opened up the ability to customize treat- ment for different patients' needs. "The early generation high add MFIOLs caused a significant loss of contrast sensitivity and had more glare and halo associated with them," said Eric Donnenfeld, MD, Rockville Centre, New York. "The newer generation of 2.5 D and 2.75 D add MFIOLs and the Symfony EDOF IOL [Johnson & Johnson Vision, Santa Ana, California] have reduced risk of contrast sensitivity and glare." Corneal astigmatism is less of a limiting factor with the newest lens options—both with multifocal toric and EDOF toric IOLs, said Elizabeth Yeu, MD, Norfolk, Virginia. Target the right patients for multifocal and EDOF lenses I n this month's "Cataract editor's corner of the world," the focus is on multifocal and extended depth of focus IOLs that are currently available in the U.S. market. We have many different types of lifestyle IOLs, so it is important to pick the right one for the right patient. It is equally as important to know in which patients not to implant one of these lenses at all or to do additional testing before proceeding. Drs. Donnenfeld, Yeu, and Berdahl help us navigate this ever-changing land- scape of IOL choices for our patients. They discuss which patients are good candi- dates, which would be better off without one of these lenses, and the importance of testing and patient education. This article gives some great insight into IOL choices for our patients. Rosa Braga-Mele, MD, Cataract editor A well-centered multifocal IOL Source: Vance Thompson, MD "That has helped expand in which patients we can implant these lenses, and this has been a nice change to our offerings in the last year," Dr. Yeu said. "The EDOF lenses have allowed us to branch out because there is an overall improved contrast sensitivity with what pa- tients are able to optically achieve." The newer options have ex- panded previously stringent criteria of what types of patients could re- ceive multifocal IOLs beyond those with low corneal astigmatism (less than 0.75 D), minimal to no dry eye, and no retinal or macular pathology or other comorbidities such as mod- erate glaucoma. "That limited us to the extreme- ly healthy eye," Dr. Yeu said. Dr. Yeu still restricts use of MFIOLs in patients with irregular astigmatism or highly aberrated cor- neas, such as post-RK or post-LASIK patients. But she will implant EDOF lenses in those with a well-centered bed from prior ablation or where the RK has not led to irregular astigma- tism, and in patients able to achieve good spectacle-corrected vision prior to cataract formation. "I have loosened my criteria

• Blank Page
• Blank Page (1)