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4 | SUPPLEMENT TO EYEWORLD DAILY NEWS, APRIL 23, 2022 Connecting the dots: Advancements in cataract surgery Patients and your practice: ATIOL pearls for patient selection F rom toric IOLs to basic multifocal IOLs to even more advanced trifocal and extended depth of focus (EDOF) IOLs, the landscape of advanced technology IOLs (ATIOLs) has certainly moved forward over the years, and it con- tinues to do so. But with so many options on the market today, patient selection is critical to ensure satisfaction. "In the last 20 years, ATIOLs have advanced leaps and bounds, which has allowed me to offer patients a level of vision correction like never before," said Zarmeena Vendal, MD. "We have gone from just wanting safe outcomes post-cat- aract surgery to expecting excellent refractive outcomes post-cataract surgery as we are now able to improve a patient's astigmatism, near vision, and even offer laser-assisted cataract surgery." Proper patient selection begins with the initial diagnostic workup and exam. "A thorough investigation of a pa- tient's ocular surface, retina, and optic nerve, as well as astigmatism measure- ment, sets a surgeon up for success. In my practice, we evaluate patients with dry eye testing and retinal imaging, and we also calculate corneal astigmatism with three different techniques. This helps us narrow down options for toric IOLs as well as the style of ATIOL that the patient may be a candidate for. We use ORA SYSTEM ® [Alcon] aberrometry to help confirm our calculations intraoperatively as well," Dr. Vendal said. Another major factor in successful patient selection for ATIOLs is setting appropriate expectations. Dr. Vendal said improved optics and advanced capabilities have increased patient expectations. "They now demand near perfect vision, and that is why it is extremely im- portant for the surgeon to set the expecta- tions in the consultation with the patient from the beginning. We never want to overpromise a result," she said. In terms of presbyopia mitigation, Alcon offers the Clareon ® PanOptix ® Trifocal IOL and the Clareon ® Vivity™ Extended Vision IOL, the latter of which is the first and only non-diffractive extended depth of focus IOL. Dr. Vendal said she's had excellent results with the PanOptix ® IOL and Vivity™ Extended Vision IOL because she makes sure they're offered to the right patients. "If the patient desires as much near ability as possible without correction and has a healthy retina/optic nerve, we use the PanOptix ® IOL very comfortably. We do always discuss nighttime artifact and describe the experience of other patients," she said. "If the patient is extremely nervous about nighttime artifact, does not mind wearing readers for more near activities, and/or has a compromised cornea, as in RK, a retina with issues like epiretinal membranes/drusen, or mild glaucoma, for example, we recommend the Vivity™ Extended Vision IOL. In the case of the Vivity™ Extended Vision IOL, we use a mini-mono approach." Dr. Vendal said her practice doesn't mix IOL technologies and has found strong patient satisfaction with bilater- al PanOptix ® IOLs or Vivity™ Extended Vision IOLs. Dr. Vendal offered pearls for setting patient expectations: 1. The surgeon should always counsel patients themselves. 2. Discuss the limitations of near vision for each lens, especially by describing daily activities. 3. Discuss nighttime limitations. 4. Even if a patient is not a candidate for certain types of IOLs, the different op- tions should still be discussed with an explanation as to why they might not be a candidate. Dr. Vendal shared two important final pearls. First, always listen to your patient. "We can do the absolute best surgery possible, but if it does not give the patient the result they are looking for, they will not see it as a success," she said. "A great example is the patient who has worn monovision-style contacts for years and ends up with multifocal ATIOLs in their eyes. This patient will likely not be happy. I cannot stress enough how important it is to ask the patient everything about their visual needs and expectations as well as their history." Second, Dr. Vendal said, it should be the surgeon's goal to be able to offer all varieties of ATIOLs in order to tailor to patients' needs. "Our patients should not have to ac- commodate to the surgeon's comfort level with ATIOLs. Rather, we should always be expanding our toolbox and staying abreast of the advances that come about so that every patient can be serviced as best as possible," Dr. Vendal said. Editors' note: Dr. Vendal is the owner of Westlake Eye Specialists in Austin, Texas. She can be contacted at zvendal@ westlakeeyes.com. Zarmeena Vendal, MD

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