This article is more than 5 years old. Information may no longer be current.
ODs well suited to discuss IOL options with patients
Click Here to Manage Email Alerts
ANAHEIM, Calif. – Here at Academy 2008, a Primary Care Optometry News Editorial Board member shared his clinical pearls on perioperative care of presbyopic IOL patients during a PCON-sponsored symposium.
 |
“Our patients are aging,” Marc R. Bloomenstein, OD, FAAO, said. “Optometry was built on refraction. Who’s better equipped to talk to patients about IOLs? Educate yourself so you can educate your patients.”
Dr. Bloomenstein stressed setting realistic expectations. Explain that the best vision will be achieved after implantation in the second eye, he said. In addition, the distance vision is fixed immediately postop, but the range will increase within a few weeks.
Dr. Bloomenstein covered three presbyopic IOLs: Crystalens (Bausch & Lomb, Aliso Viejo, Calif.), ReZoom Multifocal (Advanced Medical Optics, Santa Ana, Calif.) and Acrysof Restor (Alcon, Fort Worth, Texas).
He touted the distance vision in the Crystalens 5.0 HD. “The anterior surface of the lens has a prolate shape, which allows for more accommodative effect,” he said.
Vitreous pressure induces a forward motion with the hinges as you accommodate, he said, as the ciliary body gets thicker. “If you squeeze a water balloon, it becomes elongated,” he said. “As the ciliary mass pushes on the vitreous, it elongates and pushes forward, thus causing the accommodative effect.”
The ReZoom lens has a three-piece design with five different zones, three for distance and two for near. “There’s a transition between the distance and near,” he said, “which gives the intermediate. The refractive process takes up the anterior surface of the lens.”
 At Academy 2008, PCON sponsored Editorial Board member Dr. Bloomenstein’s talk on presbyopic IOLs. Image: Hemphill N, PCON |
The Acrysof ReStor lens has both an aspheric and a multifocal effect, Dr. Bloomenstein said. “This lens’ diffractive technology starts with a 3.6-mm optic zone. The center of this lens starts with a very high step, 1.3 microns. It slowly steps down to 0.2 microns.”
Dr. Bloomenstein noted that apodization is a gradual reduction or blending that helps minimize visual disturbances. “It does not induce as much photopsia,” he said.
“The rest of this lens has a negative spherical aberration,” added. “The average cornea has 0.27 RMS of spherical aberration. It reduces about 0.2 RMS of that. The aspheric lenses provide better quality of vision.”
“All three lenses have great results,” he said. “They have 80% overall spectacle freedom, and 94% of patients say they would have the lens again.
Dr. Bloomenstein said communicating with your patients is paramount to postop care. Compromised visual acuity could mean residual astigmatism. “About 0.50 D to 0.75 D of astigmatism can have a huge impact,” he said.
Control dry eye ahead of time. “Is the patient’s vision fluctuating? It’s dry eye,” he said.
Let patients know they may be frustrated in between lens procedures. “Sometimes they could take a year to stabilize and adjust,” he said.
“I put my patients on a 6- to 8-week leash,” Dr. Bloomenstein continued. “Don’t bring them back too soon. Let them know it could take this long.”
Patients who have poor quality of vision 1 month postop without dry eye could have cystoid macular edema. Evaluation with OCT is essential.
Opacification of the posterior capsule can be measured in a matter of seconds with a potential acuity meter and glare tester, he added.
For more information:
- Marc R. Bloomenstein, OD, FAAO, is director of optometric services at Schwartz Laser Eye Center, Scottsdale, Ariz.; (480) 483-3937; e-mail: drbloomenstein@schwartzlaser.com. He has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.