Surgeon: Patient-centered approach better for presbyopia correction

NEW YORK — Surgeons performing lens implants for the correction of presbyopia will be much better off asking which IOL is better for the patient instead of which patient is best for the procedure, advised William F. Maloney, MD. He spoke on his changed philosophy here during the Ocular Surgery News Symposium: Cataract, Glaucoma & Refractive Surgery.

If physicians take a patient-centered approach, “you’ll have much greater success and you can offer this significant advance to a much wider group of candidates,” he said.

Several patient prerequisites must be considered, he said. Among these: emmetropia. “Without emmetropia, presbyopic correction will be significantly compromised,” he said. “You need to calculate your lens implant so the spherical error is minimized to ± .25D.” Dr. Maloney credited Warren Hill, MD, as having taught him that this is possible.

Other prerequisites include patient astigmatism and capsular rupture, he said.

Above all else, Dr. Maloney said, is matching the right IOL to the patient. “If you match up the two precisely, you’ll have a satisfied patient each and every time,” he said. Surgeons need to get to know their patients “more intimately” than they do with cataract surgery, he added. Once a patient understands that he or she can’t have everything from reading acuity to night driving acuity restored to pre-presbyopic levels, their priorities change as do their expectations. Leave it up to the patient to prioritize what he or she wants, Dr. Maloney said.

Presbyopia IOL implantation involves neuroadaptation on the part of the patient, he said. The patient’s brain “doesn’t locate the blur and focuses on it, but rather in my opinion, the brain focuses on the clarity and reinforces it,” he said.

In general, Dr. Maloney added, he prefers the Array Multifocal IOL from Advanced Medical Optics for patients with large pupils and the ReStor lens from Alcon for patients with smaller pupils.