Eyeworld Daily News

APRIL 6, 2024 | EYEWORLD DAILY NEWS | 15 ASCRS ANNUAL MEETING DAILY NEWS important. There were 12 million fall-related injuries in 2017, resulting in 40,000 deaths, he said. One-third of these falls were attributable to multifocal glasses. "Each time that patient comes to us for presbyopia, they're seeking solutions, and there are some great solutions that don't have that increased risk of falling," he said. Dr. Chang went on to speak about how a balance is needed among the presbyopia-correcting op- tions when it comes to visual quality, visual range, and dysphotopsias. 'Running the Distance with Refractive Cataract Surgery' This session covered refractive cata- ract surgery in the diseased or more complicated eye. Jennifer Loh, MD, spoke about dry eye disease, saying that she tells her patients preop that their dry eye and OSD will get worse after cataract surgery. She stresses that pre- and postop dry eye treat- ment is necessary for 3–6 months. Her basic preop routine includes hypochlorous acid spray to reduce bacterial load on the eyelids, topical steroids to reduce inflammation, and warming therapy/lid expression to improve meibomian gland secretions. She said treating dry eye and MGD prior to surgery reduces postop complications, improves refractive outcomes, and increases patient sat- isfaction rates. Dr. Loh also stressed that patients seeking multifocal or to- ric IOLs should be screened for MGD and dry eye even in the absence of symptoms. Nandini Venkateswaran, MD, discussed cataract surgery in prior refractive surgery patients, following one case to highlight her points. The patient was post-hyperopic LASIK in her right eye, showed superior steepening on topography with reproducible corneal astigmatism on biometry and topography, and was highly motivated to regain her uncor- rected near vision. Dr. Venkateswaran reviewed the different IOL options for this patient, including the Light Adjustable Lens (LAL, RxSight), the IC-8 Apthera (Bausch + Lomb), or a zero spherical aberration lens. Dr. Venkateswaran said she was worried about the pa- tient's OSD and epithelial remodeling making it difficult to nail her refrac- tion with the LAL, as well as the LAL's 2 D cylinder limits. The patient didn't like the idea of dimming with the IC-8 Apthera, so Dr. Venkateswaran used an enVista toric (Bausch + Lomb). John Hovanesian, MD, covered what to do with patients who have pathology in one eye. He offered a chart that suggested what IOLs were reasonable or to avoid if patients had the potential for 20/25 vision or bet- ter in their weaker eye vs. worse than 20/25 potential in the weaker eye. In the end, it's important to identi- fy the pathology, educate patients about what they can reasonably expect with surgery and outcomes, and choose the IOL option for them wisely. Editors' note: The physicians have fi- nancial interests with various ophthal- mic companies. The refractive triathlon continues "R efractive surgery is not a sprint to the finish. It's a multiphase triath- lon," said Lisa McIntire, MD, during Refractive Day. The anal- ogy of a triathlon continued during late morning and early afternoon sessions going through the cycling (presbyopia) and running (refractive cataract surgery) phases of the race. 'Cycling the Range of Presbyopia Treatments' The presentations in this session focused on presbyopia treatment op- portunities and options. Marguerite McDonald, MD, began the session by giving an overview of the impact of presbyopia, showing videos of several presbyopes explaining how frustrating the condition is for them. There are 1.8 billion presbyopes globally, 128 million in the U.S. Of those in the U.S., 30.9 million use readers to treat presbyopia. Dr. McDonald said that two-thirds of patients seek help for presbyopia but only half receive the needed informa- tion. She also said patient education in the prior refractive surgery popu- lation is important. "I wish I had a penny for every time I heard 'my LASIK wore off,'" she said, noting that these patients are disappointed, resentful, and sometimes angry. Even if you weren't the LASIK surgeon, you may be the target of patient frustration and you must explain what happened to their vision. "We have the opportunity here to offer choices from monovi- sion or multifocal contact lenses, presbyopia drops, laser vision correc- tion, or intraocular surgery." Daniel Chang, MD, expounded upon some of the issues experienced by the presbyopic population and why the opportunities for pharma- ceutical and surgical treatment are "Refractive surgery is not a sprint to the finish. It's a multiphase triathlon." —Lisa McIntire, MD

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