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Premium IOLs for glaucoma patients are advantageous, but patient selection is key
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LOS ANGELES — Glaucoma patients can be successful candidates for premium IOLs, but patient selection and accurate preoperative measurements are necessities for success, according to a speaker here.
“Premium IOLs, especially toric IOLs, offer advantages, but patient selection is key. Accurate preoperative measurements and modern IOL formulas are essential. You must keep up to date. You must know the differences between the different formulas,” Richard A. Lewis, MD, said at Glaucoma Subspecialty Day preceding the American Society of Cataract and Refractive Surgery meeting.
Success begins with the preoperative patient interview. An ophthalmologist needs to fully understand what a patient is looking for in regards to visual needs, what he does for fun, if he does close-up work and what role he hopes glasses will play in his life. This can determine the type of IOL a patient will need, either a traditional or premium IOL, Lewis said.
No matter what lens is needed, accurate measurements and the use of the correct IOL formula are necessary to ensure success. All IOL calculations measure the anterior corneal curvature, axial length, anterior chamber depth, lens thickness and corneal diameter, he said.
Premium IOLs can help reduce spherical aberrations, glare, halos and other annoying optical phenomenon, Lewis said. There are risks with premium IOLs, he said, as toric IOLs can lead to a risk of zonular weakness or other problems.
Glaucoma patients are more at risk to have pupil problems, and poor visualization may result in higher rates of capsular tears, he said.
“It’s crucial to manage the pupil appropriately. Don’t be a hero. Use pharmacological aids, [epinephrine/lidocaine] or Omidria [phenylephrine 1% and ketorolac 0.3% injection, Omeros]. Use devices if necessary, either stretching Malyugin rings or iris hooks,” he said.
Finally, Lewis suggested avoiding multifocal lenses in glaucoma patients with cupping and/or visual field loss. – by Robert Linnehan
Reference:
Lewis RA. Premium lenses: What role in glaucoma patients? Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 5-9, 2017; Los Angeles.
Disclosure: Lewis reports no relevant financial disclosures.