Preoperative diagnostics key in determining candidates for presbyopic IOLs
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TAMPA, Fla. — Not all patients are good candidates for receiving presbyopic IOLs, but for those who are, preoperative testing helps ensure good refractive results, a speaker said here.
“The key is that preoperative diagnostics help us know who is a good candidate and who is not a good candidate for a presbyopic lens,” William B. Trattler, MD, said at the Telling It Like It Is meeting.
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While a high percentage of cataract patients are excellent candidates for presbyopic IOLs, borderline candidates include those with a history of myopic or hyperopic LASIK or a history of RK, as well as those with epiretinal membranes, vitreomacular traction or mild irregular astigmatism, for example, due to epithelial basement membrane dystrophy or small corneal scars, Trattler said.
For these patients, “if they’re motivated, maybe they can have it, but it’s not necessarily my first choice,” he said.
“They work amazingly in so many patients, but not all patients will be happy,” Trattler said.
In preoperative testing to determine candidacy for a presbyopic IOL, first Trattler assesses the patient for dry eye, meibomian gland dysfunction and blepharitis.
“It may not be obvious. Most patients don’t have symptoms of dry eye when they come in for cataract consultations, but they may have it,” he said. “We want to identify it and treat it, and if we can treat it successfully, they can be a good candidate.”
Trattler said he obtains preoperative topography to identify irregularities in the shape of the cornea as well as OCT of the macula before he sees the patient, “so I don’t have a conversation about presbyopic lenses and then realize later on that they’re not a candidate.”
For patients who meet the criteria for presbyopic IOLs, Trattler said the next step is to determine which IOL to offer.
“There are all different types of options. They all have differences, and so for me, what I’m trying to figure out is what will work best for them,” he said.
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Trattler W. Setting the stage for success: The use of diagnostics in refractive cataract surgery. Presented at: Telling It Like It Is; Feb. 15-19, 2023; Tampa, Florida.
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