Optometric Management

FEB 2017

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28 F E B R U A R Y 2 0 1 7 • O P T O M E T R I C M A N A G E M E N T . C O M CLINICAL CORNEA A S OPTOMETRISTS, we are our cataract patient's entry to care: We diagnose the condition, pre- pare them for sur- gery and oversee their post-op care. Preparing our patients for surgery includes performing a comprehensive exam (refraction, glare testing, dilation) and dis- cussing the two types of cataract surgery and the IOL options rela- tive to each patient. Regarding the latter, several recent notable advances have been made in the premium realm. To ensure pa- tients are educated about all their choices and what we feel is best for them, we must stay up-to-date on these latest offerings. Here, I discuss the premium IOLs available by category, TORIC IOLS ese are ideal for patients who have 1.00D or more of corneal astigmatism, though patients with less than 1.00D of astigmatism may benefit from a toric IOL, as len- ticular astigmatism can counter- act corneal astigmatism, and more astigmatism can be unmasked aer cataract surgery. (Obviously, ac- curate biometry and topography is critical to help surgeons decide the best course of action.) Toric IOLs provide excellent out- comes and decreased dependence on spectacles and contact lenses for distance vision post surgery. Available on the market: AcrySof IQ Toric (Alcon) and the TECNIS Toric (AMO) and the TECNIS symfony (AMO). PRESBYOPIA - CORRECTING IOLS is category includes multifo- cal, accommodating and extend- ed depth of focus (EDOF) IOLs. To start, multifocal IOLs decrease the need for spectacle dependence on distance and near vision for these patients. Specifically, light is split into two separate focal points for distance and near. e splitting of light can make these IOLs con- traindicated in patients who have optic nerve disorders, retinal is- sues and amblyopia, as these con- ditions limit vision. Also, caution should be used in patients who have other glare issues. Designs are available in high add powers, providing close near points, and in low and mid add powers. e former are ideal for patients who do a lot of close near work, such as needlework. e second is ideal for those looking for overall functional vision. e latter provide a farther near point, enabling enhanced functional intermediate and near vision, making them ideal for pa- tients who work on computers. Presbyopic "Type A" personal- ity patients usually do better in lower add power designs because they have a lower number of dif- fractive rings, which results in less symptoms of glare and halos. Some surgeons take a "blended" or "mix and match" approach when it comes to correcting presbyopia in cataract patients. is entails insert- ing a high or mid add power multi- focal IOL in one eye for more near dominance and inserting a lower or mid add power multifocal IOL in the other eye for more distance and intermediate vision. Similar to modified monovi- sion, this technique offers visual customization based on the pa- tient's lifestyle visual demands. For example, patients who read at a further near point or work a lot at the computer have improved over- all functional vision with less lost contrast sensitivity. Patients who have high myopia tend to want to keep a close near point (high add powers), and most other patients do well with a low or mid add power. e multifocal designs available on the market: TECNIS +4.0,D +3.25D and +2.75D and the AcrySof IQ ReSTOR +4.0D, +3.0D and +2.5.D. PREMIUM IOL PROFICIENCY DO YOU HAVE IT? PATIENTS DEPEND ON YOUR KNOWLEDGE JOSH JOHNSTON, O.D., F.A.A.O. IOLs in the Pipeline The following IOLs are currently in Phase 3 clinical trials in the U.S. • AcrySof IQ PanOptix Trifocal • FineVision IOL Trifocal • AcuFocus IC-8 IOL

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