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EW SHOW DAILY 4 Monday, April 28, 2014 ASCRS News Today © 2014 Novartis 2/14 VRN14003JAD-B PI IMPORTANT SAFET Y INFORMATION FOR THE VERION™ REFERENCE UNIT AND VERION™ DIGITAL MARKER CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. INTENDED USES: The VERION ™ Reference Unit is a preoperative measurement device that captures and utilizes a high-resolution reference image of a patient's eye in order to determine the radii and corneal curvature of steep and at axes, limbal position and diameter, pupil position and diameter, and corneal reex position. In addition, the VERION ™ Reference Unit provides preoperative surgical planning functions that utilize the reference image and preoperative measurements to assist with planning cataract surgical procedures, including the number and location of incisions and the appropriate intraocular lens using existing formulas. The VERION ™ Reference Unit also supports the export of the high-resolution reference image, preoperative measurement data, and surgical plans for use with the VERION ™ Digital Marker and other compatible devices through the use of a USB memory stick. The VERION ™ Digital Marker links to compatible surgical microscopes to display concurrently the reference and microscope images, allowing the surgeon to account for lateral and rotational eye movements. In addition, the planned capsulorhexis position and radius, IOL positioning, and implantation axis from the VERION ™ Reference Unit surgical plan can be overlaid on a computer screen or the physician's microscope view. CONTRAINDICATIONS: The following conditions may aect the accuracy of surgical plans prepared with the VERION ™ Reference Unit: a pseudophakic eye, eye xation problems, a non-intact cornea, or an irregular cornea. In addition, patients should refrain from wearing contact lenses during the reference measurement as this may interfere with the accuracy of the measurements. Only trained personnel familiar with the process of IOL power calculation and astigmatism correction planning should use the VERION ™ Reference Unit. Poor quality or inadequate biometer measurements will aect the accuracy of surgical plans prepared with the VERION ™ Reference Unit. The following contraindications may aect the proper functioning of the VERION ™ Digital Marker: changes in a patient's eye between preoperative measurement and surgery, an irregular elliptic limbus (e.g., due to eye xation during surgery, and bleeding or bloated conjunctiva due to anesthesia). In addition, the use of eye drops that constrict sclera vessels before or during surgery should be avoided. WARNINGS: Only properly trained personnel should operate the VERION ™ Reference Unit and VERION ™ Digital Marker. Only use the provided medical power supplies and data communication cable. The power supplies for the VERION ™ Reference Unit and the VERION ™ Digital Marker must be uninterruptible. Do not use these devices in combination with an extension cord. Do not cover any of the component devices while turned on. Only use a VERION ™ USB stick to transfer data. The VERION ™ USB stick should only be connected to the VERION ™ Reference Unit, the VERION ™ Digital Marker, and other compatible devices. Do not disconnect the VERION ™ USB stick from the VERION ™ Reference Unit during shutdown of the system. The VERION ™ Reference Unit uses infrared light. Unless necessary, medical personnel and patients should avoid direct eye exposure to the emitted or reected beam. PRECAUTIONS: To ensure the accuracy of VERION ™ Reference Unit measurements, device calibration and the reference measurement should be conducted in dimmed ambient light conditions. Only use the VERION ™ Digital Marker in conjunction with compatible surgical microscopes. ATTENTION: Refer to the user manuals for the VERION ™ Reference Unit and the VERION ™ Digital Marker for a complete description of proper use and maintenance of these devices, as well as a complete list of contraindications, warnings and precautions. 85342 VRN14003JAD-B-PI EWDN.indd 1 3/6/14 1:27 PM by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer 'Team must come together' to deliver multifocal IOL promise T he potential and complexi- ties of multifocal IOLs once again took center stage at the Technicians and Nurses Program session "Multifocal Lenses: Promise and Delivery" —this time with an emphasis on the role of the clinical staff. While it is always the case, for multifocal IOL implantation in particular, "It's so important for the team to come together," said Steven A. Nielsen, MD, Boston. Multifocal IOLs, he said, really require all parties involved to stop, slow down, and talk. Patients need plenty of guidance, since—unless they have already been using multifocal contact lenses—the vision they are about to experience is completely different from what they are used to or that they expect. For the surgeon, it is certainly "trickier surgery," said Dr. Nielsen. In addition to requiring certain surgical skills, these cases also require him to take a closer look at the chart—more so than he typically would when implanting a monofo- cal lens. This might seem like too much trouble, but handled correctly, said Dr. Nielsen, multifocal IOLs provide greater patient satisfaction. He has also had more patient referrals after multifocal implantations than after monofocals. The objective of using multifo- cal IOLs, he said, is to integrate "refractive cataract surgery" into existing general practice. It involves a paradigm shift in dealing with cataract patients, requiring a system- atic stepwise approach and "signifi- cant commitment from both doctors and staff" for success. Whereas the old focus was simply the restoration of lost vision, the new focus of cataract surgery is to optimize patient satisfaction based on the patient's particular lifestyle needs. It is thus important to ask patients about what they do in order to optimize their vision and allow them to enjoy the activities they engage in. Speaking from the technician and nursing staff's perspective, Min Cheng, COMT, Boston, said that their knowledge is crucial to increase the patients' comfort with the decision they are about to make. That decision-making process, she said, begins the minute patients step inside the office, putting tech- nicians and nurses on the frontline. At the Nielsen Eye Center, Boston, where Ms. Cheng works with Dr. Nielsen as director of clinical and surgical services, staff members adhere to a dress code and are trained in professional but warm greeting mannerisms. The goal is to provide a pleasant and welcoming environment for patients, while maintaining professionalism that maintains an efficient workflow. All the members of her staff, she said, are great communicators. They know when to answer their patients' questions about their respective cases—that is, not until the staff member has gotten to know the patients' eyes. In the meantime, they explain every test, reinforcing positivity and a sense of competence. Essentially, she said, they make patients feel they are at the right place at the right time with the right doctor, and get patients excited about their decision. The Nielsen Eye Center staff has attained such a level of competence, said both Dr. Nielsen and Ms. Cheng, that when just one staff member says that a particular pa- tient should not receive a multifocal IOL, Dr. Nielsen will schedule at least one more appointment with that patient to re-evaluate, and chances are he will find the patient in some way—subjectively, tempera- mentally, or diagnostically— unsuited for multifocal IOLs. EW Editors' note: Dr. Nielsen receives grants from Alcon, Abbott Medical Optics, and Bausch + Lomb to aid with research into their multifocal IOLs, but otherwise does not have any financial interests related to those companies. After what you have heard today, what level of postoperative UCVA do you consider a successful result to reliably drive patient referrals? 20/20 56% 20/16 40% 20/12 4% After this symposium, approximately 40% of attendees believed that 20/16 or better UCVA should be considered the successful laser vision correction result to reliably drive patient referrals. This poll was taken at the "Today's Innovations in Corneal Refractive Diagnostics, Treatments and Techniques" symposium.

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