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2 EW San Francisco 2013 Monday, April 22, 2013 Achieving optimal outcomes with multifocal IOLs by David F. Chang, MD Preop evaluation and intraop astigmatism management are critical to success P David F. Chang, MD " Determining which patients are good candidates for a multifocal IOL is a complex process, but if properly selected and informed, a certain percentage of our cataract population will be thrilled with the results. " articularly as new IOLs become available, and as more Baby Boomers require cataract surgery, interest in refractive options will continue to climb. Most ophthalmologists believe that appropriate cataract patients should be informed about these options as part of the surgical informed consent. Determining which patients are good candidates for a multifocal IOL is a complex process, but if properly selected and informed, a certain percentage of our cataract population will be thrilled with the results. Careful patient selection and effective preoperative education and counseling are time consuming, but extremely important. Patient satisfaction is very much a function of preoperative expectations, and our messaging competes with the internet, boastful friends, comparison to LASIK, and the power of suggestion that they will be rid of eyeglasses. Understandable and effective communication about expectations is just as important as the ability to make a proper capsulorhexis. I begin preoperative education by mailing handouts and my modification of the Dell refractive questionnaire to all cataract patients prior to their appointment. These carefully worded handouts explain presbyopia and astigmatism and the non-covered elective refractive options, so that Preoperative right and left eye topography and wavefront analysis of a patient who desires a multifocal IOL. The corneal higher order aberrations (within the green outline) are computed from the same corneal diameter as the patient's scotopic pupil. The high amounts of coma and spherical aberration increase the risk of poor visual quality with a multifocal IOL. Source: David F. Chang, MD patients will be better prepared to make a decision regarding their IOL. Creating a multifocal optic with two disparate focal points entails some optical compromise. Preopera- continued on page 3 Advanced continued from page 1 anterior chamber depth and the lens thickness measurements by optical biometry allows the user access to all the features of the most advanced formulas.2 Expanding your premium lens population Because of increased precision with biometry, it is likely that a higher percentage of our premium lens patients will have accurate outcomes. Combined with newer generation formulas (Holladay 2, Haigis, and Olsen), the Lenstar represents the current state-of-the-art optical biometer. tive preparation and the patient's personality and motivation can facilitate adaptation to unwanted images such as halos. Summation from bilateral multifocality helps to The Lenstar is, in short, changing how we approach the process of IOL power calculations. By allowing the user access to every part of the measurement process, along with the ability to edit the results against validation criteria, there is a significant increase in the control over the final accuracy. This precision makes the Lenstar an excellent device for surgeons who are looking to optimize their outcomes for all patients, as well as expand their premium lens patient population. References 1. Hill WE, Osher R, Cooke D, et al. Simulation of toric IOL results comparing manual keratometry to dual-zone automated keratometry from an integrated biometer. J Cataract Refract Surg. 2011; 37 (12): 2181-2187. 2. Lam S. Comparison of age-derived lens thickness to optically measured lens thickness in IOL power calculation: a clinical study. J Refract Surg. 2012;28(2):154-155. Dr. Hill is in private practice, East Valley Ophthalmology, Mesa, Ariz. He can be contacted at 480-981-6130. Please refer to page 8 for important safety information about the Alcon products described in this supplement.