Eyeworld Daily News

8 | EYEWORLD DAILY NEWS | MAY 6, 2023 ASCRS ANNUAL MEETING DAILY NEWS Talking about trifocal IOLs, Dr. Larsen said there is minimal data on the potential of multifocal IOLs in glaucomatous eyes, with most stud- ies consisting of small sample sizes. We know that multifocal lenses can have an impact on testing, Dr. Larsen said. EDOF IOLs provide an extended range of vision into the intermediate range but not as much near vision as multifocal IOLs. She mentioned both the Tecnis Symfony (Johnson & Johnson Vision) and the AcrySof IQ Vivity (Alcon). Studies reporting the use of EDOF IOLs in glaucoma- tous eyes are extremely limited, but in general, demonstrate good visual outcomes. She said that monofocal IOLs do not split light and are widely ac- cepted for use in moderate to severe disease. There are no concerns about the induction of photic phenomena, and the aspheric design inherent to most modern IOLs has been shown to increase mesopic and scotopic contrast sensitivity. Enhanced mono- focal options include the Eyhance (Johnson & Johnson Vision) and the RayOne EMV (Rayner). The Light Adjustable Lens (RxSight) may be another useful option for the lack of predictability that is increasingly seen in glaucoma patients. When considering femtosecond laser assisted cataract surgery in glaucoma patients, Dr. Larsen said this is considered safe in patients who have glaucoma. Similar efficacy and refractive outcomes have been demonstrated when combined with MIGS, she said. Dr. Larsen did note that there may be an impact on IOP. The IOP may rise about 10–16 mm Hg above baseline for 30–90 seconds while docking, and the IOP can in- crease to 60 mm Hg during standard cataract surgery and to between 70–90 mm Hg during LASIK flap creation. Still, Dr. Larsen shared data from a study that showed that IOP rise after femtosecond laser assisted cataract surgery was less than with some other ocular procedures. Additionally, using the femtosec- ond laser may be especially beneficial in some scenarios. Dr. Larsen said that, with narrow angles and shallow anterior chamber, lens pretreatments allow for less ultrasound energy use in a smaller space. For those with pseudoexfoliation, this option would be beneficial with weak zonules because it reduces manipulation and completes the capsulorhexis with less zonular stress; and for small pupils, there is the ability to adjust the capsulorhexis size to the pupil margin without concern for running underneath the iris. You still have to balance the ben- efit with the cost. Due to conditions seen more commonly in glaucoma patients, they may not be able to benefit from all the capabilities of femtosecond laser assisted cataract surgery, Dr. Larsen said. There are also some particular challenges when using the femtosec- ond laser for glaucoma patients. For those with blebs, this could impact successful docking. Associated bleb leaks have been reported, and those with thin-walled blebs may not be good candidates, Dr. Larsen said. For patients with tubes, a patch graft may impede docking. There is also the potential for erosion over the tube and the potential for capsulor- hexis disruption in long tubes, which would require manual completion. For patients with subconjuncti- val hemorrhage, Dr. Larsen said this could have an impact on the success of combined subconjunctival MIGS or filtering surgery and also possible disruption of a previously well-func- tioning bleb. She also said pupil size can be a challenge, and cortical removal can be more challenging and may be problematic in patients with weak zonules. To help maximize the benefits of advanced technology, Dr. Larsen said careful patient selection is import- ant. She also said to ramp up dry eye treatment and to combine MIGS procedures. Editors' note: Dr. Larsen has no rele- vant financial interests. Dr. Fox has no relevant financial interests. continued from page 7

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