Eyeworld Supplements

2 effect at night, and who are candi- dates for excimer laser enhance- ment, including select chronic monovision and low myopic patients. In my practice, residual refractive error and posterior capsule opacity are the leading causes of dissatisfaction post-op. I offer LASIK or PRK to patients who would bene- fit from such enhancements, as soon as the refractive error stabilizes, no sooner than 3 months post-op, and after YAG posterior capsulotomy has been performed if also indicated. Word of mouth is finally becoming a prominent factor to the point where I'm now seeing patients on nearly a daily basis who are asking for the lens by name. Dr. McCabe: One other patient group that is somewhat difficult to manage is low myopes. With a monofocal lens, patients will lose the ability to read but will gain distance vision. The loss of unaided reading vision is a difficult concept for these patients to understand; I believe this patient group is usually much better suited for a multifocal lens like the IQ ReSTOR IOL. Dr. Davidson: While showing a near card to patients, I point to the 20/200 line, and tell them that's the unaided near vision they can expect with a basic lens. Then I show them the J1-3 lines and tell them that's the improved vision they should expect with the IQ ReSTOR IOL. Implantation pearls Dr. McCabe: Ensuring you've made an appropriately sized, shaped, and centered capsulorhexis will help provide for the long-term stability of the IQ ReSTOR IOL. Centration can sometimes be difficult to assess in a dilated pupil. However, the Purkinje images of the microscope light from the lens surface and cornea can easily be superimposed on the center ring of the lens. I've found that making sure the two images are right in the center of the lens allows for perfect alignment on the first post-op day. I spend additional time in surgery confirming that the lens is centered correctly. Mastel (Rapid City, S.D.) recently introduced a rim light that attaches to the microscope and allows the patient and surgeon to see a fixation light that is helpful in aligning the lens correctly. Dr. Davidson: I also like to center the central ring of the IQ ReSTOR IOL on the first Purkinje image (the brighter, smaller reflec- tion of the microscope light). I find that by at first orienting the haptics along the 6/12 o'clock meridian, the lens is more likely to remain centered if nudging nasally is required for centration. Small, astigmatically neutral corneal wounds are important in achieving predictable outcomes because surgeons need to avoid inducing astigmatism as much as possible. Do not be surprised if minor residual refractive errors affect patient satis- faction. I've had rare patients who are 20/25, J2 unaided, and desire enhancement for –0.25+0.50X180, 20/15, J1+, and others who are 20/20, J1 with nearly a diopter of residual refractive astigmatism. A general rule of thumb is to leave the residual refractive error within 0.50 D of myopia, hyperopia, and astigmatism. Both surgeons agree no lens can promise perfection. No patient can be promised 100% spectacle freedom 100% of the time for 100% of the patient's chosen activities, but so far the IQ ReSTOR IOL comes closest to achieving those results. Dr. Davidson is medical director, NVISION Laser Eye Center, Camarillo, Calif., assistant clinical professor of ophthalmology, Jules Stein Eye Center, Los Angeles, and in practice at Miramar Eye Specialists, Ventura, Calif. Dr. McCabe is medical director and partner, The Eye Associates, Sarasota, Fla. Contact information Davidson: doctorjohn@johndavidsonmd.com McCabe: cmccabe@theeyeassociates.com EW Chicago 2012 Sunday, April 22, 2012 2 My practice is booming— baby booming, that is Davidson/McCabe continued from page 1 E very day, 10,000 baby boomers turn 65, and the number of Americans over age 65 is expected to double within 7 years. 1 As baby boomers approach the age of cataract onset, the rate of cataract surgery will increase dramatically. Even if the number of ophthalmol- ogy residents were to double tomor- row, there would still not be enough surgeons to serve this growing need. As the demand for cataract surgery continues to surpass the available workforce of surgeons, I believe laser refractive cataract surgery will become the norm. Technologies such as the LenSx Laser (Alcon, Fort Worth, Texas) combined with advanced technol- ogy IOLs will play a prominent role in cataract treatment. The baby boomer population presents a unique demographic of cataract surgery patients—they are educated, technologically savvy, and demanding when it comes to their health. To provide the best treat- ment for this patient population, I think options such as the AcrySof IQ ReSTOR IOL (Alcon) and LenSx Laser technology are a must heading into the future. A rapid shift At the Eye Center of Southern Indiana, we adopted the IQ ReSTOR IOL in September 2010. Prior to this, we used an accommodative lens technology as our primary premium lens. Unfortunately, about 20% of our accommodative lens patients were dissatisfied, which necessitated additional chair time and doing whatever we could to make the patients happy and to give them the best possible vision. Since adopting the IQ ReSTOR IOL technology, I've implanted more than 215 lenses. The swing toward the IQ ReSTOR has been swift. There is less patient dissatisfac- tion post-op along with outcomes that usually give patients independ- ence from glasses—more than 90% of my patients are doing well and are satisfied at about 6 weeks post-op. No lens is perfect, but using the IQ ReSTOR IOL has required less chair time, fewer post-op issues to address, and yields significantly by Dan Grossman, M.D. " No lens is perfect, but using the IQ ReSTOR IOL has required less chair time, fewer post-op issues to address, and yields significantly more patients who leave our offices happy " Dan Grossman, M.D. Please refer to page 12 for important safety information about the Alcon surgical products described in this supplement. Alcon Sunday supplement_Chicago2012-12pages_Layout 1 4/20/12 4:50 PM Page 2

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