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57 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, Los Angeles 2017 Dr. Thompson advocates monovision, as long as the patient has a clear lens that is quantified. If a patient enjoys monovision with a contact lens to address presbyopia, he urges them to stay with a con- tact. Corneal corrections become an option if they don't like the contact lens. He urged surgeons to keep the potential loss of lingering accommo- dation in young cataract patients. "We can work our way up that accommodative loss with extended depth of focus and multifocal lens- es," Dr. Thompson said. Dr. Thompson said low add multifocals and extended depth of focus IOLs "have changed the game" among his cataract patients. He noted that presbyopia-cor- recting lenses need to add a refrac- tive laser fine tuning at the end. Among the lenses Dr. Thomp- son offers patients are extended depth of focus (EDOF) lenses, which don't have various "sweet spots" of some other lenses. "Since you're not splitting light you're not seeing this reduction in nighttime image quality," Dr. Thompson said. Dr. Cionni urged caution with cataract patients who are used to reading without their glasses. Such patients may benefit from a mix of a low add multifocal and slightly higher add multifocal. "Patients will still get good distance vision with both eyes but they'll have an intermediate and a near point that they can rely on," Dr. Cionni said. EW Editors' note: This event was supported by educational grants from Johnson & Johnson Vision (Santa Ana, Califor- nia), Alcon (Fort Worth, Texas), and Carl Zeiss Meditec. by Rich Daly EyeWorld Contributing Writer about the quality of their 20/20 vision if they have it—is it sharp 20/20?" One of his favorite measure- ment tools is the refractive light scatter index with the HD Analyzer (Visiometrics, Costa Mesa, Califor- nia). When patients provide a pin- point index he knows their cornea, tear film, and lens are healthy. "Even though they are pres- byopic, I can be thinking about a corneal correction of presbyopia," Dr. Thompson said. Meanwhile, in cases with a high light scatter and good tear film, Dr. Thompson looks to an IOL implant. Dr. Thompson uses the Penta- cam (Oculus, Arlington, Washing- ton) for corneal topography, but it also has a great way to quantify lens density. The key diagnostics for Robert Cionni, MD, Salt Lake City, was a comparison of readings from the Atlas 9000 Corneal Topog- raphy System (Carl Zeiss Meditec, Jena, Germany) and the LENSTAR (Haag-Streit, Koniz, Switzerland). Twenty-three percent of sympo- sium attendees said they are not cur- rently offering presbyopia-correcting IOLs to their cataract patients. Meanwhile, the biggest barrier to performing more presbyopia-cor- recting IOL procedures in their prac- tice was listed as the cost to patients by 73% of respondents to the 2016 ASCRS Clinical Survey. Dr. Thompson focuses on patient symptoms and diagnostics when looking at the possibility of IOLs in presbyopia patients. "I'm really listening to patients about nighttime image quality with their best optical devices and what they are thinking," Dr. Thompson said. In the three stages of dysfunc- tional lenses—presbyopia, lens yel- lowing and haziness, and cataracts— Dr. Thompson noted the middle stage can be the most confusing. "These people are having dif- ficulties in near—either with just reading or with their glasses or bi- focals," Dr. Thompson. "I ask them S urgeons are increasingly confident in offering more presbyopia-correcting lens options after a review of them. Attendees at an EyeWorld CME Education symposium reported increased confidence offering such presbyopia-correcting tools after a panel of experts discussed the roles of the growing number of alterna- tives. Specifically, the share of at- tendees somewhat or not confident fell from 26% before the presen- tation to 16% after it. Meanwhile, those who were very or extremely confident offering such options increased from 49% to 57%. "There are certainly some that don't put any in but that number is diminishing as we go over the years," said Vance Thompson, MD, Sioux Falls, South Dakota; presby- opic patients now comprise 40% of his cataract cases. "As we're seeing the momentum it represents the quality of the lenses we have avail- able to us now." Increasing surgeon comfort with presbyopia-correcting options Dr. Thompson says the growing share of presbyopic patients among his cataract cases stems from the increasing quality of available lenses.

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