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by Dwayne K. Logan, MD Pathway to multifocality the positive. We strive for perfection. We tell patients, "This is not like your God-given lens, but it certainly is the next best thing." If a patient drives regularly at night, I steer them away from these IOLs. It's not worth the potential risk of disability. I share that the most significant issue is cost, which they will discuss with our premium IOL counselor. We explain financing options. For some reason, when patients know they can make payments on these implants, they tend to choose them. Conclusion I am comfortable speaking with my patients about multifocal IOLs, but some physicians are reluctant to broach the subject. You must believe in the technology in order to present the premium channel in your clinic. I look my patients in the eyes and enthusiastically offer them the technology that will improve their lifestyle. I have implanted these lenses in execu- tives, medical directors, surgeons, and even a patient who drives a fire truck. I always ask myself, "Would I place a multifocal lens in my family, friends, col- leagues, and even my own eye?" The answer to all of those is, "Yes, I would." Dr. Logan is the founder and medical director of Atlantis Eyecare in Huntington Beach, Calif. He can be contacted at dklogan@atlantiseyecare.com. Because we will always have patients who insist that we explained they would never need glasses and their vision would be 20/20, we must document everything. We require patients to sign forms indicating that they correctly understand what they've been told. If patients have more than 2 D of astig- matism, I explain that they are candidates for monofocal glasses or a monofocal toric IOL. We offer a broad range of toric IOLs, as well as the new Trulign Toric (Bausch + Lomb, Bridgewater, N.J.). I explain to patients that no one must have cataract surgery. If their vision is 20/100, I tell them that this surgery is optional, but it will help them see better. Discussing IOL options If patients elect to have cataract surgery, we discuss their lifestyle choices (Figure 2). Do they want to be dependent on glasses with a standard monofocal IOL? Or do they want to be less dependent on glasses and opt for a multifocal, presbyopia-correcting IOL? We explain that these IOLs will allow them to enjoy their near and distance vision, and they should be able to perform their hob- bies without spectacles, however, we do not over promise. We caution them that they may need to occasionally wear glasses and may ex- perience mild dysphotopsia. We explain that halos are normal with all IOLs and should dissipate over time. I'm not afraid to tell them that I truly believe in this technology, and I focus on Surgeons who present multifocal IOLs need to value the benefits of this technology W hen presenting multifocal intra- ocular lenses (IOLs) to patients, it is important to understand how various options can be personalized to meet their individual needs. Cataract surgery candidates When cataract patients arrive in our office, staff are instructed to determine their refrac- tive error and whether they have astigmatism. If patients have less than 2 D of astigma- tism, I explain that they are candidates for monofocal glasses or multifocal IOLs, which decrease dependence on glasses (Figure 1). We never tell them that they will be spectacle- free, although more than 90% of our patients with multifocal IOLs do not need glasses. Figure 1. IOL options for cataract patients Figure 2. IOL choices based on lifestyle Cataract patient <2 diopters of astigmatism >2 diopters of astigmatism Monofocal with glasses Multifocal decreased dependence on glasses Monofocal with glasses Toric Dependence on glasses. Standard monofocal IOL Decreased dependence on glasses. Multifocal presbyopic correcting IOL If you decide to have surgery, your next decision is a lifestyle choice 8 Copyright 2015 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or the publisher, and in no way imply endorsement by EyeWorld or ASCRS.

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