14
EW San Francisco 2013
Saturday, April 20, 2013
Careful patient
counseling and screening
are two keys to patient
satisfaction
I
have had a very high patient
satisfaction rate with multifo-
cal IOLs, and the keys to opti-
mal patient satisfaction are
patient screening, meticulous
surgery, and patient counseling. In
addition to screening patients from
an anatomy and disease standpoint,
I also consider patients' needs,
desires, and personality. Patients are
counseled about nighttime glare and
halos, which are inherent with these
lenses due to their design.
Patient screening
The first step toward success with
multifocal IOLs is careful patient
screening. If a patient has macular
degeneration, diabetic retinopathy,
or severe pseudoexfoliation with
phacodonesis, I may decide not to
even offer multifocals as an option
because the risk of a poor outcome
may be high. Additionally, patients
who have no desire to reduce their
need for glasses or contact lenses
would obviously not be interested in
this technology. I also rule out any
patient who appears to be a perfec-
tionist and any patient who indi-
cates that he or she is sensitive to
glare and halos at night. I also typi-
cally don't consider multifocal IOLs
in patients who have previously un-
dergone corneal refractive surgery
due to the risk of poor quality of
vision.
Most patients are good candi-
dates for multifocal IOLs. If I have
not ruled patients out during this
initial screening, I then pay careful
attention to their ocular surface,
both from the lipid layer and aque-
ous layer point of view. I examine
the lids and lashes carefully for mei-
bomian gland disease. If I have any
suspicion about any macular abnor-
malities, I perform a macular OCT. I
also examine the optic nerve to
make sure the patient doesn't have
pre-existing optic nerve disease.
Maximizing the ocular surface
allows us to get good keratometry
and corneal topography measure-
ments. All patients undergo corneal
topography to determine how much
corneal astigmatism they have.
Patients with more than 0.75 D of
corneal astigmatism who choose
multifocal IOLs will likely require
laser vision enhancement postopera-
tively because toric multifocal IOLs
are not yet available in the United
States. We also will get a pachymetry
measurement. Pachymetry com-
bined with topography determines
whether a laser vision enhancement
can be performed.
14
by Elizabeth A. Davis, MD, FACS
Achieving success with
multifocal IOLs
"
The first
step toward
success with
multifocal
IOLs is careful
patient
screening.
"
Elizabeth A. Davis, MD, FACS
Figure 1
Figure 2
Source: Elizabeth Davis, MD
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