Eyeworld Supplements

have to make decisions about patients we don't know very well. Frequently we're meeting the patient for the first time, and we have precious little time to establish what kind of a person we are facing and what type of vision he will likely enjoy most after surgery. One thing I look at is how the patient presents for surgery. A patient who presents hysterical about 20/20 minus 3 vision and is insisting on im- mediate intervention is very different from someone with a 20/80 cataract saying he doesn't mind going on with the same vision for another year. Those are very different people because they've adapted to different levels of visual imperfection. We also make great use of ques- tionnaires, where we ask patients what they would like to see with and without spectacles post-operatively. We ask them how much visual compromise they'd be willing to accept and where they'd be most willing to use specta- cles if they had to. We try to get some idea of their tolerance of glare and visual imperfections in general. By the time they reach me, they realize that there are compromises associated with all these lenses, and they've got a common vocabulary be- cause they've seen videos and they've read materials that explain the differ- ent options. Then I assess patients both on paper and in vivo, considering what they tell me, what they've written down, as well as what I see in them during their physical examination, whether they have glaucoma or macu- lar degeneration, for instance, and then I issue them a recommendation. Dr. Kent: We use a standardized questionnaire that asks questions that place patients on a scale between perfectionist and easygoing. The patients who tick the far end of the spectrum of perfectionist—don't put multifocals in those ones; they do fine with the Crystalens AO because they still have a good quality of vision. Even if they have to wear glasses for some things, those patients are happy. Dr. Lindstrom: We assess everything, collecting all the subjective and objec- tive information we can to make a rec- ommendation. The good news is we now have multiple data sets that tell us what the different lenses can do. Dr. Yogi, how do you set patient expectations? What do you emphasize when you're going to implant a Crystalens AO in a patient? Dr. Yogi: In the beginning, I used to explain too much for the patient. I used to take 15-20 minutes explaining how the IOL might work or not. But as I gained more experience with the IOL and its performance, I found myself talking less and less because I think the IOL is more predictable in terms of side effects, and it's rare for patients to complain of any kind of visual difficul- ties. I mainly tell them about the expectation of visual performance for near and intermediate. That's not the case with multifo- cals. With multifocals, I need to take the time to explain the side effects to make sure patients understand and will be tolerant of those symptoms if they appear. I think it's easier to talk to patients about the Crystalens AO beforehand. On the other hand, I spend more time with them in the post-operative period following implantation with the Crystalens AO because of the dynamic nature of its performance. Dr. Fernandez: I tell patients what they can expect from the lens for sure—that the Crystalens AO provides the best quality of vision, the best intermediate vision. I think they have to know that the near vision they can achieve is a kind of social near vision—they can read their watch, their smartphone—and that's the key. 8 March 2012 Advancements in accommodating IOL technology: A global perspective " In terms of contrast sensitiv- ity, the accom- modative IOL is better than the multifocals, and that differ- ence is significant in our study. There was also a significant difference in terms of halos and starbursts between the Crystalens AO and the two multifocals " Robert T. Ang, M.D.

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