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50 | EYEWORLD DAILY NEWS | MAY 7, 2019 ONSITE ASCRS ASOA ANNUAL MEETING by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor do an enhancement until at least a month after surgery. He also discussed problematic near point. Patients often do not give a good assessment of how much they use their near vision, and this can lead to implantation of two high pow- ered IOLs where they lose reading vision. He said it's best to target a continuous range of vision by mixing an EDOF with a low add multifocal for these patients. Neu- roadaptation can be a subjective cause of dissatisfaction for these patients. Editors' note: The event was supported by educational grants from Alcon and Johnson & Johnson Vision. Dr. Garg also highlighted pa- tient selection for an EDOF IOL. He said to assess the visual po- tential and screen for pre-existing conditions, determine the degree of astigmatism, and account for the refractive starting point and age. Wrapping up the presenta- tions, John Berdahl, MD, Sioux Falls, South Dakota, discussed measuring visual function, which he noted can be measured objec- tively and subjectively. Residual refractive error is the single biggest reason for dissatis- faction after having a presbyopic IOL, and he said that it's import- ant to have an exit strategy. The most common strategy is having access to excimer laser, but he said you probably don't want to was that monovision patients don't have significant glare or halos postop. Dr. Farid said that these can still occur, but the patient just does a good job suppressing it. The second myth was that patients who have a successful experi- ence with contact lens mono- vision should have monofocal IOL monovision. Pseudophakic monovision is not the same as contact lens monovision, she said. Contact lens patients have levels of accommodation that an IOL patient no longer has, and contact lens monovision power differenc- es are not as great as required for IOL monovision. Contact lens monovision patients are great candidates for presbyopia IOLs, Dr. Farid said. These patients have demonstrated success with neuro- adaptation. Also during the session, Thomas Kohnen, MD, PhD, Frankfurt, Germany, discussed trifocal IOLs, while Sumit "Sam" Garg, MD, Irvine, California, presented on EDOF options. Dr. Kohnen offered several pearls for trifocal lenses, stressing the importance of a preoper- ative evaluation, postoperative refraction, centration and size of the capsulorhexis, and patient information. He has found high patient satisfaction and spectacle independence with trifocals but also noted that optical phenomena can occur. He said this may work particularly well in patients with a clear cornea, regular astigmatism, and a healthy fundus. The rationale for EDOF IOLs, Dr. Garg said, is to balance quality of vision, multifocality, and night vision symptoms. Dr. Garg discussed the Tecnis Symfony (Johnson & Johnson Vision) and mentioned some of the advantag- es of an EDOF over a multifocal. You get a range of vision, rather than one or two "sweet spots." It also doesn't split light, so there's less loss of distance clarity and contrast acuity, he said. A n EyeWorld CME Education event on Monday covered "The Correction of Presby- opia in Today's Cataract Practice: Maximizing Quality of Vision, Functional Vision, and Pairing the Treatment to the Patient's Needs." The program chairs were John Vukich, MD, Madison, Wisconsin, and Elizabeth Yeu, MD, Norfolk, Virginia. Marjan Farid, MD, Irvine, California, first discussed mono- vision and what we can do better. She started out with "what we know." Pseudophakic monovi- sion is widely practiced but little studied, Dr. Farid said. Mono- vision patients see clearly by an interocular suppression of blur. Some patients may not be able to suppress the blurred image. This suppression comes with tradeoffs in binocular summation, stereop- sis, and contrast sensitivity, she said, adding that neuroadaptation occurs over 3+ weeks. Dr. Farid presented the pros and cons of IOL monovision. Pros: • Cost effective • Good monocular quality of vision • Less sensitivity to decentration • Less sensitivity to capsular opacification/contraction • Better solution if the patient develops macular disease or other conditions that reduce contrast sensitivity Cons: • Loss of stereopsis • Loss of binocular summation • Risk of asthenopia • Limited intermediate vision • Need spectacles for night driv- ing and prolonged reading. Dr. Farid addressed a couple myths of monovision. The first Presbyopia in today's cataract practice Dr. Kohnen discusses trifocal IOLs during an EyeWorld CME Education event.

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