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14 EW San Francisco 2013 Saturday, April 20, 2013 Careful patient counseling and screening are two keys to patient satisfaction I have had a very high patient satisfaction rate with multifo- cal IOLs, and the keys to opti- mal patient satisfaction are patient screening, meticulous surgery, and patient counseling. In addition to screening patients from an anatomy and disease standpoint, I also consider patients' needs, desires, and personality. Patients are counseled about nighttime glare and halos, which are inherent with these lenses due to their design. Patient screening The first step toward success with multifocal IOLs is careful patient screening. If a patient has macular degeneration, diabetic retinopathy, or severe pseudoexfoliation with phacodonesis, I may decide not to even offer multifocals as an option because the risk of a poor outcome may be high. Additionally, patients who have no desire to reduce their need for glasses or contact lenses would obviously not be interested in this technology. I also rule out any patient who appears to be a perfec- tionist and any patient who indi- cates that he or she is sensitive to glare and halos at night. I also typi- cally don't consider multifocal IOLs in patients who have previously un- dergone corneal refractive surgery due to the risk of poor quality of vision. Most patients are good candi- dates for multifocal IOLs. If I have not ruled patients out during this initial screening, I then pay careful attention to their ocular surface, both from the lipid layer and aque- ous layer point of view. I examine the lids and lashes carefully for mei- bomian gland disease. If I have any suspicion about any macular abnor- malities, I perform a macular OCT. I also examine the optic nerve to make sure the patient doesn't have pre-existing optic nerve disease. Maximizing the ocular surface allows us to get good keratometry and corneal topography measure- ments. All patients undergo corneal topography to determine how much corneal astigmatism they have. Patients with more than 0.75 D of corneal astigmatism who choose multifocal IOLs will likely require laser vision enhancement postopera- tively because toric multifocal IOLs are not yet available in the United States. We also will get a pachymetry measurement. Pachymetry com- bined with topography determines whether a laser vision enhancement can be performed. 14 by Elizabeth A. Davis, MD, FACS Achieving success with multifocal IOLs " The first step toward success with multifocal IOLs is careful patient screening. " Elizabeth A. Davis, MD, FACS Figure 1 Figure 2 Source: Elizabeth Davis, MD AMO Saturday supplement_SF2013-dl.qxp_Layout 1 4/19/13 11:27 PM Page 14

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