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Presbyopia Correcting IOLs “Just Works” Says Ophthalmologist
mivision | 5 April 2017
Dr. McCartney told an audience in Sydney that many presbyopic patients – even those with cataracts – realistically expected and desired an IOL implant to deliver good quality near, intermediate and distance vision with spectacle independence and minimal side effects.
Although an IOL implant for presbyopia is by no means a medical necessity, he said this desire made the procedure one to be taken seriously and that surgeons had a duty to advise patients of all their options.
Dr. McCartney said discussing IOLs with a presbyopic patient takes time. “When talking to patients about the Panoptix, I give them a brief explanation of presbyopia… I use models to describe and demonstrate the IOL… and I tell them, this is not the perfect solution we want, the perfect solution has not been invented yet, but this is the best solution I have seen for your type of eyes.
“I stress spectacle independence must be a priority as they need to be patient in the adaptation phases. I tell them it’s not like wearing multifocal glasses where you have to look up and down to find the right spot... I tell them it’s like having bugs on your windscreen – your retina and brain are presented with different images – but your brain looks right past the bugs and pays attention to the correct image… it’s almost an automatic selection.”
Dr. McCartney said it was important to explain the compromises – the haloes which will settle over time, glare sensitivity and shadowing in high contrast situations. Additionally he said patients need to be reassured that occasional use of glasses was acceptable and that wearing glasses would significantly enhance vision for detailed work. He said the potential need for LASIK, vitrectomy for floaters, and IOL exchange should also be discussed, including the risks of each.
Dr. McCartney spoke about pre- and post-op procedures, stressing the need to screen for other eye diseases in the process. He discussed multi-focal IOL options available for presbyopes and concluded, “Patients love the PanOptix – they seem to adapt to it really well. I think there are a couple of reasons – its utility – it works naturally... it delivers what we set out to achieve. Because patients are not having frustrations at different distances, they concentrate on aberrant phenomena less,” he said.
“I think the other thing is the exceptional light utilisation… (which) probably makes it a much better day to day lens to live with – 88 per cent transmittance at 3 mm pupil size really is an engineering success.”
Dr. McCartney stressed the need to show patients empathy as they adapt to the new lens. “This is a much lower care post-op lens than some of the other multi-focals, however you will go on a journey with your patients. Be prepared to take time, offer patients care and consideration. Demonstrate what they can see – but don’t minimise subjective reports or difficulties.”
A panel discussion with Dr. Anton Van Heerden from Armadale Eye Clinic in Victoria, Dr. Smita Agarwal from Wollongong Eye Specialist Centre in NSW and Dr. Paul McCartney concluded the evening, providing further opportunity for delegates to share and learn about clinical experiences.
Increased light transmission probably makes it a much better day to day lens to live with