Eyeworld

EW MEETING REPORTER 134 February 2018 Reporting from Hawaiian Eye 2018, January 13–19, Maui, Hawaii intraoperative aberrometry to aid in this. Pearl two was to optimize outcomes by mixing and matching multifocal and extended depth of fo- cus IOLs. "We can optimize patients' eyes by mixing and matching," she said. But which IOL do you choose? Dr. Farid said it's important to ask about the patient's lifestyle and daily activities to make the correct choice. Her top pearl was "Don't forget the ocular surface/tear film." You need to optimize the surface to get better outcomes, she said. Editors' note: Dr. Farid has financial interests with a number of ophthalmic companies. Changes to benefit cataract surgeons and patients During his presentation, Kevin Mill- er, MD, Los Angeles, offered what he thinks are 10 things industry partners should do for the benefit of cataract surgeons and their patients. He counted down with his 10 sug- gestions. 10. Develop cloud-based sync services that can get in through hospital firewalls to push changes made on any one phaco machine, femtosecond laser, or operating microscope to all other identical instruments in all facilities where a surgeon operates. cal IOLs have identical satisfaction. Mixing low and high add multifo- cals improves computer vision and glare/halos relative to bilateral high add lenses. Editors' note: Dr. Hovanesian and Dr. Berdahl have financial interests with a number of ophthalmic companies. Pearls in cataract practice Marjan Farid, MD, Irvine, Califor- nia, shared her top five pearls in cataract practice. She counted down, with her fifth pearl being to look at corneal spherical aberration. The natural cornea has positive spherical aberration, but the post-hyperopic LASIK cornea has negative spherical aberration. SA creates halos in high contrast and edge unclarity, and this could impact which IOL the surgeon chooses. The fourth pearl was to account for posterior corneal astigmatism. The posterior cornea is a minus lens that creates a net plus power along the horizontal meridian. You have to take into account that there is more against-the-rule astigmatism from posterior cornea than is shown in the total corneal astigmatism. Dr. Farid said to undertreat with- the-rule astigmatism and overtreat against-the-rule to account for this. Dr. Farid's third pearl was to nail the spherical power, and she uses Causes of unhappiness may include refractive error, dryness, pos- terior capsule opacification, positive dysphotopsia, a problematic near point, and patients who are visually demanding. The most common problems occur because of refractive error, he said, noting that though this may be the case, it's not the thing to treat first. Formulas and aberrometry help mitigate refractive error, but multifocality and astigmatism may compound the issue. Dr. Berdahl said excimer enhancements are still needed. Most patients will be very happy if you can get them to refrac- tive neutrality. Before you treat the refractive error, you need to make sure the source of the refractive error is not dryness, Dr. Berdahl said. Dryness can be addressed with lubrications, medications, and thermal pulsation. Positive dysphotopsia are "part of the multifocal journey," Dr. Berdahl said. This issue is one of the most frustrating parts and could require an IOL exchange. Among Dr. Berdahl's suggestions for the unhappy, visually demand- ing patient were to treat everything else first (except YAG), discuss neuroadaptation, and to consider an IOL exchange. John Hovanesian, MD, Laguna Hills, California, described studies his practice has done to determine patient satisfaction outcomes. He noted that "patient fears are not what you'd expect." Two of the most common patient concerns he saw in one study were blurry vision and wearing glasses. Dr. Hovanesian noted that 96% of patients were "somewhat" or "very" satisfied. Based on the studies, Dr. Hova- nesian concluded that satisfaction is high if you hit the refractive target, and he suggested that it's important not to leave greater than 0.5 D of astigmatism. True spectacle independence greatly increase satisfaction, but this is difficult to obtain, with only around 25% achieving this. At 5 years, Dr. Hovanesian said that accommodating and multifo- View videos from Hawaiian Eye 2018: EWrePlay.org Audrey Talley Rostov, MD, discusses ways in which femtosecond technology can help with dense lenses and in cases of zonulopathy. Sponsored by

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