Eyeworld Daily News

EW SHOW DAILY 34 ASCRS Symposia Sunday, April 15, 2018 the plan for the second eye might change based on the outcomes with the first. Dr. Donaldson said her patient wanted spectacle indepen- dence, was pre-treated for dry eye, and ended up receiving a Tecnis Symfony EDOF in the first eye. Due to the patient requesting more near vision and experiencing no dyspho- topsias postop, she placed a Tecnis multifocal in the second eye. The patient was happy with his out- come and used readers in dim light settings. Dr. Hoffman said the dry eye conditions of this case (and the fact that the patient was an attorney) makes him nervous, so he would have used an EDOF with a little bit of monovision, rather than a multifocal in the second eye. Daniel Chang, MD, Bakersfield, California, said he would take a similar ap- proach to that of Dr. Donaldson, but noted that he would decide whether to do another EDOF or a multifocal in the second eye based on how the patient's vision was with the first. Next, Dr. Tipperman prompted a lively discussion about whether or not to YAG a patient with posterior capsule opacification in an eye with a multifocal lens; the capsule was fibrotic and wouldn't polish. This patient said he never had truly clear vision after the surgery. Dr. Donaldson said she never likes to YAG patients who say their vision was never clear after surgery. If the issues were more related to the IOL itself and an exchange was necessary, the complication rate increases in the presence of an open capsule. Dr. Hoffman said he would YAG this lens, suspecting the patient would be happy afterward, while Dr. Raviv said he is suspicious there is more to it than just the opacifica- tion. He said he would lean against YAG in favor of an exchange with a monofocal lens or doing the second eye with a monofocal IOL before deciding what to do with the first. A raise of hands from the panel and the audience revealed most would opt to YAG the patient first rather than go for an exchange right away. In the end, Dr. Tipperman said the patient elected to have an ex- change done and still needed a YAG afterward to achieve the crisp vision he was looking for. EW Editors' note: The physicians have financial interests with various ophthalmic companies. patients, but they are not guaran- teed near vision without glasses. Dr. Vukich speculated that the patient was doing well at near due to the astigmatism; as such, he said he would try monovision and leave the astigmatism alone in the non-dom- inant right eye, knowing that he could go back and do an LRI later, if needed. Richard Tipperman, MD, Bala Cynwyd, Pennsylvania, said you could always do a contact lens trial to allow the patient to expe- rience what monovision would be like. Dr. Raviv ended up placing a Tecnis Symphony EDOF toric (Johnson & Johnson Vision, Santa Ana, California) in the patient's non-dominant eye, providing excellent distance and intermediate vision and near vision that was good enough that the patient could read without glasses in well-lit scenarios. Dr. Donaldson presented a case of mixing and matching EDOF and multifocal IOLs. The most important considerations are setting appropri- ate patient expectations and remem- bering that it's a two eye process, so Challenging continued from page 33

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