Expert offers pearls for matching patients with the right IOL
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LAS VEGAS — With so many IOL options available, choosing the right one can be tricky.
In his presentation at Refractive Subspecialty Day at the American Society of Cataract and Refractive Surgery meeting, Gerd U. Auffarth, MD, PhD, gave pearls for matching the right IOL with the right patient.
“We’re really tailoring a solution for each patient and going down to actually tailoring a solution for each individual eye,” he said.
Although they might not be highly regarded in some circles, Auffarth said monofocal IOLs are not bad.
“We have a lot of patients with difficult IOL calculations,” he said. “They may have a highly aberrated cornea, an irregular astigmatism or other pathology where you really have no other choice.”
Auffarth also uses “enhanced” monofocal IOLs such as the Tecnis Eyhance IOL (Johnson & Johnson Vision), which can provide better refractive tolerability, a better landing zone and refractive tolerability of astigmatism in post-LASIK and other patients.
Auffarth said enhanced monofocal IOLs may be a good fit and provide better outcomes if patients have a difficult IOL calculation, glaucoma or other chronic pathology, and they may even be used as an “enhanced” mini-monovision to get some refractive output out of it.
A crucial step in selecting an IOL is exploring a patient’s visual needs.
“Sometimes doctors and patients speak a different language. They mean other things than you would interpret,” Auffarth said. “How important is spectacle independence? What distances are relevant? What kind of job do they do? Is the patient committed to compromises?”
Finally, Auffarth said it is important to remember optical physics of extended depth of focus lenses and multifocal IOLs.
“Increasing depth of field will reduce vision quality,” he said. “You can’t expect to have a lens that can cover all distances, can make them read at 20 cm and still have no dysphotopsia.”
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Auffarth GU. Pearls for choosing the right IOL for the right patient. Presented at: American Society of Cataract and Refractive Surgery meeting; July 23-27, 2021; Las Vegas.
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