Eyeworld Daily News

EW SHOW DAILY 30 ASCRS Symposia Tuesday, April 21, 2015 Croma Pharma (Ft. Lauderdale, Fla.), and iMed Pharma (Montreal, Canada). Dr. Kohnen has financial interests with AMO, Alcon, Bausch + Lomb, Carl Zeiss Meditec (Jena, Germany), Hoya (Tokyo), Neoptics (Hunenberg, Switzer- land), Oculus (Lynnwood, Wash.), and Rayner (East Sussex, U.K.). Dr. Chang has financial interests with AMO, Al- lergan (Irvine, Calif.), Calhoun Vision (Pasadena, Calif.), Clarity Medical Systems (Pleasanton, Calif.), LENSAR (Orlando, Fla.), PowerVision (Belmont, Calif.), RevitalVision (Lawrence, Kan.), and Transcend Medical (Menlo Park, Calif.). by Rich Daly EyeWorld Contributing Writer from those that are coming from the cornea. That can show a surgeon the presence of large amounts of coma, which also is a reason to waive off multifocals. "Who is a candidate? That's the person I'm relatively sure I can satisfy," Dr. Chang said. EW Editors' note: Dr. Slade has financial interests with Alcon (Fort Worth, Tex- as), Bausch + Lomb (Bridgewater, N.J.), Glaukos (Laguna Hills, Calif.), and Revision Optics (Lake Forest, Calif.). Dr. Arshinoff has financial interests with Abbott Medical Optics (AMO, Ab- bott Park, Ill.), Alcon, Bausch + Lomb, patient now had intermediate but the patient basically does not ask you anymore about these things," Dr. Kohnen said. "They have a con- tinuum of vision and that makes it much easier, in terms of selection of trifocal lenses." For David F. Chang, MD, Los Altos, Calif., the choice for many of his presbyopia-correction pa- tients is between monofocals and mini-monovision, and the later is the leading choice. "Many of those patients are happy to hear about reduced specta- cle vision, but if they knew that they had a choice between quality vision and convenience, they certainly don't want any unwanted images and are concerned about that," Dr. Chang said. Among the potential problems for multifocal lenses that Dr. Chang highlighted is the severe impact of even a small amount of astigmatism. A multifocal is a good fit for Dr. Chang's patients if they hate glasses, have healthy, binocular, emmetropic eyes, as well as reasonable expecta- tions. Reasons to avoid such lenses include the presence of abnormali- ties or abnormal-sized pupils. "This has really saved me many times; maybe they could have gotten away with it but for me it's a little too risky," Dr. Chang said. It's also important to exam- ine corneal optical quality with a topographer that can separate aberrations coming from the lens T he potential failure of the only lens approved for marketing by the Food and Drug Administration to provide accommodation remains a key selling point for Stephen G. Slade, MD, Houston. "The fact that it is a monofocal is important because, at worst, it still provides monofocal vision," Dr. Slade said about the Crystalens (Bausch + Lomb, Bridgewater, N.J.) during a symposium by members of the Intraocular Implant Club. In Dr. Slade's experience, the lens generally has been reliable in providing the promised 1.5 D of accommodation. The IOL's best results are in intermediate vision, while it has proven less effective in improving near vision. The results are a visual acuity trade-off but one that works in the modern era, where people are more likely to want clear views of their handheld devices than close book reading. Dr. Slade leaves it up to the patient to decide whether they prefer the greater sharpness of the Crystalens or the greater chance of uncorrected vision that multifocal lenses can provide patients with healthy eyes. "We sit down with the patients that express an interest in this sort of technology and just lay it out to them," Dr. Slade said. Meanwhile, the use of pres- byopia-correcting IOLs continues to lag, with only 7% of implanted lenses in that category, according to the 2014 ASCRS Clinical Survey. Steve A. Arshinoff, MD, FRCSC, Toronto, Canada, recom- mends monofocal or extended focus lenses for professional or avid athletes. For patients that are heavy readers, who want sharp vision, far and near vision, no halos and no glasses, he would suggest monovi- sion. For patients strongly motivated to give up their glasses and whose eyes are healthy, Dr. Arshinoff sug- gests multifocals. Thomas Kohnen, MD, Frank- furt, Germany, said he has seen a shift from bifocal to trifocal lenses in recent years. Rotationally asymmet- ric multifocals appeared to fill a gap he has seen in the multifocal's abili- ty to provide intermediate vision. "When we added the trifocal lenses it was not only that the Trade-offs continue in presbyopic solutions Members of the Intraocular Implant Club present a symposium on the various tradeoffs involved with existing presbyopic solutions. " Many of those patients are happy to hear about reduced spectacle vision, but if they knew that they had a choice between quality vision and convenience, they certainly don't want any unwanted images and are concerned about that. " –David F. Chang, MD

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