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A key for every surgeon implant- ing premium IOLs is finding the tools most likely to produce a higher percentage of 20/happy patients. The Crystalens ® AO and TRULIGN ® toric intraocular lenses (Bausch + Lomb, Bridgewater, N.J.) have become a big part of my premium practice because their visual side effects have been less than those of multifocal lenses in my practice, and they can be used in a broader range of patients. For surgeons just beginning to implant theses lenses, the ideal patients are mild to moderate hyperopes. Ideal patients for ex- perienced surgeons could range from a high myope to a hyperope. Using the Crystalens and TRULIGN toric as premium lenses allows us to help a wider selection of patients than we can with multifocals because we don't 3 continued from page 2 Post-injection view of the enVista almost fully unfolded Source: Dee Stephenson, MD Finding the right lens for a premium experience by Jeffrey Whitman, MD continued on page 4 lenses available today in terms of looking at computers, cell phones, and handhelds. But they may need light readers if they are going to read fine print, particularly in less-than- ideal lighting. 8,9 Our alternative to that is that we may decide to overcorrect the non-dominant eye by 0.5 to 0.75 D to give them better reading vision. If they can accept that they may need to wear light readers, either option can usual- ly work out very well. In my hands, up to only 10% of these patients may need some type of enhance- ment surgery, such as laser vision correction. We like to let them know beforehand so they're not surprised if they end up a little overcorrected or a little undercorrected. We want the patient to know we can fix that. If it's premium lens surgery, they deserve a premium experience and as premium a result as we can get. Additionally, we ask that they initial next to J3 on a reading card if they could be happy with that level of vision. Otherwise, that patient may not be a good candidate, and we may need to look for alternatives. have to worry about the amount of aberra- tions such as coma or contrast sensitivity loss that can be an issue with multifocals. 9 Another type of patient who we some- times forget is the post-refractive surgery patient, such as those who have undergone LASIK, PRK, or radial keratotomy. The devel- opment of very accurate formulas to calculate powers for these previous refractive surgery patients allows many of these patients who already decided that they wanted to get rid of glasses to have improved outcomes with less spectacle dependence. Additionally, the TRULIGN toric is a great lens for a toric patient who wants a wider range of vision. 8 A key element in satisfactory postop outcomes for these lenses is setting postop ex- pectations preoperatively. It's very important to have very good preop discussions—either with the physician or a counselor—which should include reviewing the well-known pros and cons. We tell TRULIGN toric and Crystalens patients that our goal is to get very good to excellent distance and intermediate vision. It's one of the best intermediate-type aberrations. Glare and halos with multifocals are not tolerated well by my patients. Among current toric IOLs, the TRULIGN ® toric IOL is elevated above the rest as the first toric IOL that offers a broader range of vision. 8 Its rotational stability has been outstanding in my experience. 8 I target the non-dominant eye from –0.25 to –0.50 and target the dominant eye plano to –0.25, and this has led to many happy patients in my practice. The current market offers toric IOLs based solely on monofocal platforms, and although they can correct astigmatism and distance vision, the patient still must wear glasses for near and intermediate vision. The TRULIGN toric IOL is set apart from other toric IOLs by providing a presbyopia-correct- ing toric lens that gives the broadest range of vision currently available. 8 Dr. Stephenson is owner of Stephenson Eye Associates in Venice, Fla, and president of the American College of Eye Surgeons. She can be contacted at eyedrdee@aol.com.

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