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Survey: Cataract procedures declined in ’05
SAN FRANCISCO — The number of cataract surgeries performed in 2005 fell 60,000 from the 2004 level, while the number of LASIK procedures remained relatively unchanged, according to results from the annual survey of members of the American Society of Cataract and Refractive Surgery.
David V. Leaming, MD, and Richard J. Duffey, MD, surveyed 4,645 active U.S. members of ASCRS and received 725 responses (16%) to their 2005 Survey of Practice Styles and Preferences.
The estimated annual volume of cataract surgery was 2.79 million procedures, according to the researchers, down from 2.85 million in 2004. The estimated volume of refractive procedures, including PRK, LASIK and LASEK, also declined slightly, to 928,737 procedures in 2005. The change was less than 1%, and Drs. Leaming and Duffey noted that LASIK growth has been relatively flat since 2001.
The number of surgeons performing bimanual microincision cataract surgery increased slightly, to 4.4% of all procedures in 2005 and from 3.3% of all procedures in 2004. Of those using the technique, 50% said they use it in 10% of cases, and 25% said they perform bimanual phaco exclusively. In 2004, 62% of surgeons using the technique said they did so in 10% of their patients, while 31% performed bimanual phaco only.
Drs. Leaming and Duffey noted that 7.4% of respondents said they plan to switch to bimanual phaco within the next year.
Between August and October 2005, one-third of the respondents opted to implant presbyopic IOLs; the other two-thirds indicated they expect to begin implanting the lenses within the next year.
More presentations from ASCRS are highlighted in the remainder of this article. Many of these items appeared first on OSNSuperSite.com as daily reports from the meeting. Look to the print pages of Ocular Surgery News for expanded coverage in the future.
Refractive
Failure to verify treatment parameters can lead to LASIK errors
Preoperative verification of a patient’s refractive error and treatment parameters are crucial in avoiding mistakes during LASIK, Sonal Dave, MD, said.
Dr. Dave said she assessed factors involved in the misprogramming of LASIK cases and found a need for greater preoperative evaluation and involvement by surgeons.
“In all of these cases, the errors were avoidable,” Dr. Dave said.
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Image: Mullin DW, OSN |
A retrospective chart review found programming errors for 10 eyes of eight patients who underwent LASIK. In three cases, the errors involved entering incorrect astigmatic axis. Two cases involved entering the incorrect quantity of sphere, and one case each involved programming the wrong astigmatic power, performing a myopic correction on a hyperopic patient and performing the treatment on the wrong patient.
In the last case, the patient allowed the surgeon to call him “José” several times, believing the surgeon was making a joke. Only after one eye had been treated incorrectly did he clarify that his name was “Carlos,” Dr. Dave said.
“One might wonder how it is possible to misidentify a patient,” Dr. Dave said. “But it does occur, and medical errors result.”
The cases that involved incorrect astigmatic axis data resulted in mild to moderate postoperative refractive errors, which were corrected with subsequent laser enhancement, she said. The cases involving inputting significantly incorrect astigmatic power or sphere resulted in severe overcorrection, making enhancements difficult, she said. All the patients in these cases needed corrective lenses. The patient who received another patient’s correction incurred moderate myopia, which was re-treated with LASIK.
All the errors were a direct result of minimal preoperative evaluation by the surgeon. In some cases, the surgeon did not assess the patient at all before entering the laser suite for treatment, Dr. Dave said.
“Remember the four S’s,” she said. “Remember to check the sticker, site, screen and source document. You don’t want to discover that you have the wrong information after it’s too late.”
Frozen irrigation solution may alleviate post epi-LASIK pain
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Image: Boyle EL, OSN |
A topical, frozen balanced salt solution may reduce pain associated with surface ablation procedures, according to a study.
Bruce C. Larson, MD, assessed the effectiveness of preoperative treatment with frozen balanced salt solution as a means of alleviating the pain experienced within 24 hours after epi-LASIK.
The study looked at a series of 39 consecutive epi-LASIK procedures. The control group consisted of an initial series of 18 eyes that received standard epi-LASIK. A second consecutive series of 21 eyes received 50 drops of frozen balanced salt solution applied directly to the cornea before undergoing epi-LASIK. At day 1 postop, all patients were asked to rate their level of pain on a scale of 0 to 10, and the two groups were compared for the level of postoperative pain control.
For those who had been given the drops preop, the average pain score on a per-eye basis within the first 24 hours was 1.4 on a scale of 0 to 10.
Of the 18 eyes (11 patients) that had not been treated with the frozen solution, the average pain score reported within the first 24 hours was 4.
“The results were pretty dramatic,” Dr. Larson said. “This has largely eliminated one of the barriers to surface ablation – pain.”
Nomogram accounts for aberration interactions
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A nomogram for laser refractive surgery that accounts for the interactions of certain higher-order aberrations may improve results in PRK and LASIK, according to a speaker here.
Manoj Subbaram, MD, said the interaction of preoperative higher-order aberrations can have significant effects on sphere and cylinder after laser refractive surgery.
“Compensating for these interactions can definitely improve results of LASIK and PRK,” he said.
Dr. Subbaram noted that in the clinical trial data submitted to the Food and Drug Administration for premarket approval for the Bausch & Lomb Zyoptix laser system, “there was only moderate predictability of postoperative refractive error,” with 76% of eyes within ±0.5 D of target.
In an effort to improve this result, Dr. Subbaram and his co-author Scott M. MacRae, MD, analyzed the study results and found that overcorrection was five times more likely in the study than undercorrection. In addition, they found that the eyes with overcorrections had greater amounts of defocus, spherical aberration and third-order root mean square aberrations.
“This gave us a clue that there might be something going on in terms of aberration interaction that affects our postoperative results,” he said.
Eyes in the study with a lot of postoperative positive spherical aberration tended to be hyperopic, Dr. Subbaram said, leading to the hypothesis that defocus is related to spherical aberration. The researchers also noted a relationship between fourth-order secondary astigmatism and second-order astigmatism.
“And this is just the tip of the iceberg,” he said. “There are a lot more interactions going on.”
The nomogram they devised uses the patient’s preoperative manifest refraction and compensates for the aberration interactions that the researchers “decoded,” Dr. Subbaram said.
The new nomogram was evaluated in a series of 508 eyes, of which 445 underwent LASIK and 63 underwent PRK. The LASIK eyes had a mean preoperative refractive error of –4.5 D, and the PRK eyes had a mean preop refractive error of –6.6 D. All eyes had a high degree of preoperative higher-order RMS, at least 0.5 µm.
At 1 month postoperative, the sphere and spherical equivalent were “pretty much at zero,” Dr. S said, and all eyes were within ±1 D of plano.
In addition, 94.6% of PRK eyes and 90.5% of LASIK eyes had uncorrected visual acuity of 20/20 or better, he said.
Shared nomogram provides good results in early LASIK cases
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A nomogram based on multiple centers’ pooled data can provide good LASIK results in the early period of using a new excimer laser, a study presented here showed.
The database also allows the surgeon to improve on initial results by constructing his own personal nomogram, according to one user of the system.
David A. Wallace, MD, said using the SurgiVision DataLink system after he acquired a WaveLight Allegretto Wave laser reduced his “nomogram angst.”
Dr. Wallace said the DataLink system is a Web-based, simplified version of the Kezirian Refractive Consultant. It pools data from U.S. sites that are using the Allegretto Wave laser system. According to WaveLight, about 30% of U.S. users of the Allegretto Wave subscribe to the DataLink system.
Dr. Wallace said that in his first 65 LASIK cases performed with the system, in eyes with up to 7 D of myopia, 84% of eyes achieved uncorrected visual acuity of 20/20 or better.
After gathering follow-up data on his patients for 2 months and building his own personal nomogram, his results improved, with 94% of eyes achieving 20/20 or better UCVA, he said.
In the multicenter U.S. trials for regulatory approval of the Allegretto Wave, 91% of comparable eyes achieved 20/20 or better UCVA, he noted.
Dr. Wallace’s enhancement rate also decreased, with 5.4% of eye requiring enhancement with the pooled data nomogram and only 3.2% needing enhancement with his surgeon-specific nomogram, Dr. Wallace said.
“DataLink helped ease the angst that any surgeon faces when transitioning to a new laser system,” Dr. Wallace said.
Most basal cells in epi-LASIK flaps are not viable, histology study shows
Up to 90% of basal epithelial cells in epi-LASIK flaps may be dead or crucially damaged when they are replaced onto the stroma, a histology study showed. Most superficial and intermediate cells in the flaps may still be viable, however.
At the meeting, Shigeru Kinoshita, MD, described a histologic study he performed on epi-LASIK flaps that were created using three brands of microkeratome. The microkeratomes used were the Gebauer device now distributed by CooperVision Surgical, the Norwood EyeCare Epikeratome and the Moria Epi-K device.
Small peripheral sections of epithelial flaps created by each device were trimmed off with fine scissors immediately after the excimer laser ablation during epi-LASIK. The sections were processed for transmission electron microscopy (TEM) or confocal microscopy.
About half of the 22 samples showed an intact basement membrane on TEM. Staining indicated that 90% of the cells in the basal layer were dead or damaged.
Dr. Kinoshita said the high percentage of non-viable cells in the basal layer was “probably due to mechanical damage from the epikeratome cut.” He said epi-LASIK is a worthwhile surgical procedure, but the instrumentation must be improved in order to make the basal cells more biologically active.
Cataract/IOLs
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Image: Mullin DW, OSN |
No link between macular thickness and gentamicin in irrigating solution
The use of gentamicin in balanced salt solution cannot be conclusively linked to increased macular thickness 1 week after cataract surgery, according to a study presented here.
Yoshilde Nakai, MD, and colleagues looked at macular thickness before and after cataract surgery in 91 eyes. The researchers used optical coherence tomography to analyze the macula. The eyes received either balanced salt solution with or without gentamicin.
The mean thickness was 187 µm on day 7 postoperatively for the eyes that had gentamicin in the solution and 185 µm for those that received saline alone.
The researchers said “a link could not be established” between the use of gentamicin in the balanced salt solution and increased macular thickness.
“We found that gentamicin can be used safely and effectively when added to balanced salt solution,” Dr. Makai said.
Multifocal IOLs can be used in glaucoma patients
Patients with glaucoma can be candidates for multifocal IOL implantation, but surgeons must select the patients with care, according to Richard A. Lewis, MD.
He said diffractive and refractive multifocal IOLs can be used effectively in glaucoma patients, but there are special considerations for these patients.
New baseline visual fields and disc images should be obtained following multifocal IOL implantation in glaucoma patients, Dr. Lewis advised. Factors to be considered in patient selection include the degree of IOP control, the presence and health of a bleb, and the proximity of visual field defects to central fixation.
Patients should be told about all considerations concerning their disease and the surgery prior to IOL implantation, Dr. Lewis said.
“Counseling the patients is important so they know what the risks are,” he said.
He said it is important to counsel glaucoma patients about the procedure because they could have unrealistic expectations. Patients should be told that the surgery will most likely reduce reliance on glasses but not eliminate them. Halos and blur may also occur, Dr. Lewis said, which may be a consideration for some patients.
“There are certain patients who like wearing glasses, especially those with night vision occupations,” Dr. Lewis said.
He noted that trabeculectomy can induce astigmatism, and this can play a “very important role” in visual results.
Exclusion criteria for multifocal IOLs include more than 1 D of corneal astigmatism, pre-existing ocular pathology and previous refractive surgery, Dr. Lewis said.
After patients are counseled and cleared for the surgery, the surgery itself must be meticulous and the IOL well centered, he said.
Telescopic multifocal IOL designed to address needs of low-vision patients
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A small-incision foldable telescopic IOL may significantly improve quality of vision for patients with age-related macular degeneration, according to Gholam A. Peyman, MD. He described the development of a two-zone, aspheric, three-lens design for patients with AMD during the ASCRS Innovators’ Session.
“Approximately 14 million patients suffer from low vision due to late-stage AMD,” Dr. Peyman said. “These patients require special visual aids for reading.”
The central optical zone of the new telescopic IOL provides 3X magnification for central vision, and a peripheral zone provides normal peripheral vision.
The anterior element of the lens is a small-diameter (1.5 mm), aspheric lens with high positive power. The posterior element is a larger diameter (6 mm) two-zone lens. The central portion, with a diameter of 1 mm, provides additional negative power for the telescopic zone, Dr. Peyman said.
The periphery of the posterior element provides standard IOL power to allow the patient to focus on distant objects.
According to Dr. Peyman’s abstract, theoretical optical evaluation of the telescopic IOL showed that patients achieved 3X angular magnification at a distance of 25 mm. In addition, the peripheral portion of the posterior lens provided focusing for distant objects, as well as peripheral vision for a very wide angle.
“This lens provides unobstructed peripheral field, as well as 3X magnification,” Dr. Peyman said. “Clinical investigation in human trials will start in 6 weeks outside the United States.”
Multifocal, monofocal combination has high patient satisfaction
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Implanting one multifocal and one monofocal lens can offer patients improved near and distance vision, said Richard Tipperman, MD.
Dr. Tipperman suggested that surgeons may consider piggyback placement of ReSTOR IOLs (Alcon) in patients who previously had bilateral monofocal IOLs implanted. He presented results from a subset study of 10 patients implanted with the ReSTOR lens in one eye and the AcrySof monofocal lens (Alcon) in the fellow eye. Nine patients had been previously implanted with two monofocal lenses.
Patients were given a questionnaire asking them to describe their “feelings” and “thoughts” about such everyday activities as reading, watching television and using the computer, with or without glasses. They rated their vision quality on a 10-point scale, he said.
Nine patients graded reading with glasses as at least a 6; nine were able to watch television comfortably (graded a 10), and seven patients rated using a computer comfortably as an 8.
Dr. Tipperman cautioned that the study was small and “not scientific,” but is a start at examining patient expectations and outcomes.
“It’s a way of beginning to look at [combination implantations],” he said.
Phakic IOLs may help patients gain lines
A phakic IOL is effective in correcting spherical and astigmatic errors, while offering a safe, efficient and stable surgical outcome, Sabine Buchner, MD, said.
She presented results in 66 eyes that had been implanted with the Artisan/Verisyse IOL (Ophtec Advanced Medical Optics). The preoperative refraction ranged from –21.25 D to –0.25 D in 50 eyes with myopia; 16 eyes with hyperopia ranged in refraction from +2 D to +6.13 D.
The annual cumulative cell loss of 1.7% was as expected, she said. In the group with myopia, at 3 years 85% had gained one or more lines of acuity. Of those with hyperopia, 70% had gained one or more lines at the same follow-up period, she said.
Glare complaints rare with aspheric lens
Complaints of glare or reduced night vision were virtually nonexistent in a study of patients implanted with the SofPort AO silicone aspheric lens, P. Dee G. Stephenson, MD, said.
Dr. Stephenson compared the Bausch & Lomb SofPort AO, the non-aspheric SofPort SE and Tecnis (Advanced Medical Optics) lenses. Dr. Stephenson said patients implanted with the non-aspheric lenses had night glare problems and required Nd:YAG laser within 9 months after initial implantation.
Since September 2004, Dr. Stephenson has implanted 525 SofPort AO lenses. At 1 year postop, she said, 85% of patients had 20/20 best corrected visual acuity. Patients also reported improved night vision, which was a major consideration for them, she added.
“In my practice, this is the No. 1 complaint – about a decrease at nighttime driving,” she said.
If decentered, the SofPort AO does not induce higher-order aberrations, Dr. Stephenson said. If tilted, it induces less higher-order aberrations than other IOLs, she added. The effective lens power is unaffected by pupil size, she stated.
Four multifocal IOLs provide excellent near and far vision
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Four multifocal IOLs have “effective functional systems at all distances and limited side effects,” said Ulrich M. Klemen, MD.
Dr. Klemen spoke about four lenses: The Array, ReZoom and Tecnis (Advanced Medical Optics) and the Acri TwinSet. He said though the three-piece, hydrophilic acrylic AcriTwin from Acritec has not been approved for use in the United States, it is widely used in Europe, so it was included in the study.
Dr. Klemen randomized 60 eyes of 40 patients who had a mean baseline visual acuity of 0.8 to receive one of the lenses. All patients had binocular implantations within 1 week.
“We have excellent functions for both near and far,” he said.
After implantation, 15% of the patients with the Array used spectacles, compared with 10% who had the Acri Twin, 12% who had the ReZoom and 10% who were implanted with the Tecnis. A total of 10 eyes developed halo or glare: three eyes with the Array, two eyes with both the AcriTwin and ReZoom lenses and one with the Tecnis.
Dr. Klemen said he asked patients if they would have the surgery again, with the following results: eight patients each who had the Array, AcriTwin or ReZoom would repeat the surgery; nine patients who had the Tecnis would repeat the surgery.
Accommodating lens shows better results than conventional
The eyeonics crystalens accommodating IOL has “measurable improvements in near vision” when compared to conventional IOLs, said Jonathan M. Davidorf, MD.
He described results of an ongoing, non-randomized, unmasked prospective study in 124 eyes of 71 patients who underwent standard coaxial phacoemulsification with IOL implantation. He said comparative studies of accommodating vs. conventional IOLs are rare, making it difficult to counsel patients on which lens to choose.
“We don’t understand it, so how can we talk about it with our patients?” Dr. Davidorf said.
In his trial, patients were implanted with either the Alcon AcrySof (53 eyes) or the eyeonics crystalens (71 eyes). Best corrected near vision was measured using a Jaeger card through distance manifest refraction.
Accommodative amplitude at 1 m was 1.52 for the crystalens and 0.83 for the AcrySof, Dr. Davidorf said. At 3.6 m, values remained the same.
Dr. Davidorf said after patients adjusted to the crystalens, he found uncorrected near vision was more improved than was documented in the study, with a slightly myopic endpoint and bilateral implantation.
“In use, it’s even more powerful,” he said. “In the real world, you’re looking out of both eyes.”
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Image: Boyle EL, OSN |
Simultaneous bioptics reduces surgeries
Patients who have simultaneous bioptics surgery can avoid second surgeries in most cases, Roberto Zaldivar, MD, said.
Dr. Zaldivar said success in simultaneous bioptics is reliant on patient iridectomies, accurate white-to-white measurements and skillful technique. He added that simultaneous bioptics surgeries are painless for the patients.
He conducted a study comparing sequential and simultaneous bioptics on 59 eyes, with follow-up on day 1 and at 1 month. With the simultaneous bioptics, he said, patients have better initial visual acuity.
“I have had great patient satisfaction,” he said.
Potential disadvantages of simultaneous bioptics are a longer surgical procedure, complicated calculations and a higher possibility of complications because the patient is undergoing two procedures in the same operative session. There is also a possibility of residual refractive defects, he said.
Mixing, matching IOLs good option for quality vision
No single lens is ideal for every patient, making mixing and matching IOL technologies viable for better patient satisfaction, said Richard L. Lindstrom, MD.
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![Richard L. Lindstrom, MD [photo]](/images/commonart/lindstrom.jpg)
Dr. Lindstrom, Chief Medical Editor of Ocular Surgery News, said every IOL technology has plus and minuses, rendering mixing in some cases the best option for better vision. He said mixing different optical systems is not a new idea, with multifocal/monofocal and monovision contacts regularly combined. A newer idea, the mixing of conventionaly multifocal or accommodating lenses, is yet another option, he said.
“If you mix and match appropriately, you can lead to higher patient satisfaction,” Dr. Lindstrom said.
He said staged implantation provides a “safety net” for the surgeon to guard against possible patient dissatisfaction. He said the process works by first choosing an IOL for the first eye, waiting for feedback from the patient about the quality of vision with that lens at about 2 to 4 weeks postoperative. Then the surgeon chooses the second IOL. If patients were pleased with the first lens, the same lens can be implanted. If they are unhappy with the first lens, a different lens is selected, he said.
“Think about what the patient is unhappy about and put in another lens for the second eye accordingly,” he said.
Good visual performance, patient satisfaction shown with Tecnis ZM
The diffractive TecnisZM lens has “excellent visual performance,” and may be useful for emmetropes and low myopes, Georges D. Baikoff, MD, said.
Dr. Baikoff spoke about the clinical results of implanting the Tecnis ZM (Advanced Medical Optics) lens in patients with hyperopia and presbyopia.
Over the course of 2 years, he implanted the lens in 15 patients whose mean age was 57 years. The majority of patients were hyperopic, he said. The average preoperative refraction was +2.44 D, with a range from –8 D to +6.25D.
According to Dr. Baikoff, the IOL corrects presbyopia with “excellent near distance,” but patients should be warned of possible side effects, such as night halos. He said most of his patients accepted night vision problems.
Patients should also be forewarned about the possible reduction in vision at some distances, Dr. Baikoff said. He added that he spends “a lot of time” before surgery with his patients, describing the procedure outcomes and the technology.
“It’s very important to tell the patients any kind of presbyopia surgery will be a compromise,” he said. “They gain something in near vision, and they lose it in distance.”
The Tecnis multifocal silicone IOL lens provides “excellent reading ability” for patients with presbyopia, Daniel A. Black, MD, said.
Dr. Black spoke about his first 50 cases using the Tecnis multifocal. He implanted the lens in 48 eyes of 24 patients with hyperopia, aged 41 to 70. Patients had “good distance vision and mild photic phenomena only,” he said. After surgery, patients could read five-point type, he said.
“These patients can pick that up and read it,” Dr. Black said.
Dr. Black had implanted the AMO Array and the eyonics crystalens before using the Tecnis multifocal, but he said he stopped using the other IOLs because the near vision was not as good. Both Array and crystalens had “excellent distance vision,” but neither had adequate reading vision, he said.
“The patients did not read well in my series,” he said. “Patients need more near performance.”
The three-piece, large-optic, difractive Tecnis lens, has equal light distribution and is independent of pupil size. He minimized tilt or decentration, ensured the IOL was in the bag and the optic was covered by the interior capsule. He also used a capsulorrhexis marker. He found the aspheric platform lens provided good reading at standard six-point type using standard lighting.
“You have superb reading performance,” Dr. Black said.
Topical NSAIDs may improve vision in IOL patients
Administering keratolac tromethamine 0.4% both preoperatively and postoperatively may improve the visual outcomes for patients who have undergone a multifocal IOL implantation, according to Eric D. Donnenfeld, MD.
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![Eric D. Donnenfeld, MD [photo]](/~/media/images/news/print/ocular-surgery-news/2006/04_april_15/donnenfeld_70_90_16742.jpg)
“I think over the past year or so, we have seen a revolution, with multifocal IOLs becoming increasingly popular,” Dr. Donnenfeld said. “We wanted to look at the effect topical non-steroidal anti-inflammatory drugs have on the quality of vision for people with multifocal IOLs.”
He described a multicenter prospective study to assess the effect of ketorolac tromethamine 0.4% four times daily for 3 days preoperatively and for 3 weeks after multifocal IOL implantation. Results were compared with control patients; emphasis was on quality of vision. About 40 patients had been implanted bilaterally with the ReSTOR multifocal IOL (Alcon), he said.
Uncorrected visual acuity, best corrected visual acuity, mesopic and photopic contrast sensitivity were assessed at 2 weeks and 3 months after the second eye implantation. Lifestyle questionnaires given at 3 months showed the patients who were also given keratolac tromethamine had improved satisfaction with their multifocal IOLs compared to the patients who were not given the NSAID.
Dr. Donnenfeld added that using topical NSAIDs may also help prevent cystoid macular edema (CME).
“There’s a myth that CME is not common, but in fact it is common,” he said. “Preoperative and postoperative topical NSAIDs are important in patients receiving multifocal IOLs. This brings me to the point that we have really raised the bar on how we judge our outcomes. Snellen acuity is important, but quality of vision is the most important.”
Dynamically accommodating IOL a ‘tremendous’ refractive tool, surgeon says
A “clamshell dynamically accommodating” IOL may be an “excellent” device for refractive lens exchange, said Keiki R. Mehta, MD. He said the lens is capable of correcting high myopia and high hyperopia while retaining accommodation.
Dr. Mehta said that the lens provided a reduction in dependency on postop refractive correction, and that the lens should be implanted through a clear corneal incision. He shared his results from 214 implantations here at the meeting.
“Most of the patients are 20/30 or better and they are very happy with the fact that they have no need for glasses,” he said.
At 42 months, the mean uncorrected visual acuity improved from 6/36 to 6/9 at distance and from J7 to J1 at near. In 87% of the cases, best corrected visual acuity was 6/6; J1 was obtained in 74% of the patients, Dr. Mehta said. IOP ranged from 14.6 mm Hg to 17.5 mm Hg. The mean amount of postoperative accommodation was +2.5 D. Dr. Mehta said no complications were noted.
Dr. Mehta said the lens can be injected through a standard 2.8 mm incision. Even with lateral compression, he said, once locked, the lens plates do not separate. It is unlikely to lead to fibrosis, he said.
“The lenses fit in smoothly, and once the two rings are fit together, they don’t separate,” he said. “You simply fold it and inject it.”
He said the key to implanting the lens is getting it inside the bag.
“It’s a great system,” he said. “We do believe this is the lens of the future.”
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Image: Mullin DW, OSN |
IOL allows spectacle independence
Nearly 100% of patients receiving an apodized diffractive IOL in a study were spectacle-free 1 year after surgery, Robert A. Kaufer, MD, said.
He spoke about a year-long study he conducted in Argentina on a total of 51 patients implanted with the ReSTOR IOL (Alcon).
Dr. Kaufer said 99% of patients had spectacle freedom, and 100% would have the same surgery again. They would also recommend the surgery to their best friend, he said. The majority of patients reported no or mild night vision problems, halo or glare. The side effects were deemed “tolerable” by the patients and were not intrusive enough to forego having the surgery, they said.
The mean uncorrected distance vision was 20/20, and mean uncorrected near visual acuity was 20/16. Mean uncorrected intermediate VA was 20/25, Dr. Kaufer said.
Mixing multifocal IOLs results in better overall vision
Combining two different multifocal IOLs in one patient can result in a high rate of spectacle freedom and patient satisfaction, said Frank A. Bucci, Jr., MD.
Dr. Bucci initiated a study in which one cohort received the ReSTOR IOL (Alcon) in both eyes and a second cohort received the ReSTOR lens in one eye and the ReZoom lens (Advanced Medical Optics) in the contralateral eye. The ReSTOR-only group comprised 55 patients with a mean follow-up of 27 weeks. The mixed group comprised 39 patients with a mean follow up of 12 weeks.
In the ReSTOR-only group, 21 patients had cataracts and 24 had refractive lensectomies. “Implanting the ReSTOR in the second eye improved reading and caused no added halos,” he said.
The first group had a near visual acuity of J1, while the mixed-lens group had a near VA of 1.07, Dr. Bucci said. There was no statically significant difference at near, he said.
No statistically significant differences in bilateral uncorrected near vision were observed, he said.
For near vision, ReSTOR was excellent in bright light for small pupils, while the ReZoom was very good in moderate light for medium pupils, Dr. Bucci said. For intermediate vision, ReZoom was excellent, while ReSTOR sacrificed intermediate for fine detail at near, he said. For distance, ReZoom had excellent bright daylight vision, while ReSTOR had less light phenomena at night.
“Why are we mixing technologies? Because it works,” Dr. Bucci said.
In the discussion following his paper presentation, Dr. Bucci said that he had started using ReZoom in the nondominant eye but switched to using ReZoom in the dominant eye and ReSTOR in the nondominant eye because he had heard too many complaints from patients about unilateral issues.
He called ReZoom a “viable” option and said if ReSTOR did not exist, he would use ReZoom in both eyes.
“ReZoom is rescuing the ReSTOR instead of the other way around,” he said.
Presbyopia course takes a ‘patient-centered approach’
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![William F. Maloney, MD [photo]](/images/commonart/maloney.jpg)
A course presented here focused on a “patient-centered approach to presbyopia correction.”
William F. Maloney, MD, Ocular Surgery News Cataract Surgery Section Editor, presented the course, “Presbyopia Correction 2006: Essential Keys to Success.”
“This is an annual event put on by the editorial board of OSN. We focus on the best topics of the year, one of which is, no doubt, presbyopia correction,” Dr. Maloney said.
More than 300 people attended the course, which also addressed topics including preoperative assessments for successful presbyopia correction regardless of IOL choice and presbyopia correction with conventional IOLs.
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