Eyeworld Supplements

5 Q&A: How three surgeons go the distance with ACTIVEFOCUS What patient characteris- tics lead you to conclude that a patient is an ap- propriate candidate for AcrySof IQ ReSTOR +2.5 with ACTIVEFOCUS Optical Design IOL? Steve Scoper, MD: The best candidate for this multifocal option for cataract surgery is a patient who desires an extended range of vi- sion and reduced glasses use. Most of my patients understand that they will likely need to wear reading glasses—particularly in dim lighting—but most want uncompromised distance vision without resorting to glasses or contacts. Matt Hammond, MD: These lenses are ideal for someone who is interested in excellent distance vision, or potentially does a lot of intermediate work such as computer work. These lenses are great for patients who really want crystal clear distance vision. Anatomi- cally, we look for the same things we would consider with any multifocal lens: a normal cornea, low astigma- tism (less than 1.0 D) or at least a plan to address the astigmatism, and low coma or other aberrations that would prevent them from being a good candidate for any multifocal. What do you tell your pa- tients about ACTIVEFOCUS to set expectations? Dr. Scoper: I tell patients that I want to give them great distance vision without glasses. With ACTIVEFOCUS, I can give them pretty much uncompromised distance vision—similar to a standard monofocal IOL. There are some reports of more visu- al disturbances like halos and starbursts, but with my patients, these have been minimal due to the ACTIVE- FOCUS design. I have had a lot of experience with multifocals during the past 10 years or so. I implanted some of the first multifo- cals in our area. Initially, my main desire was to give patients good uncorrected near vision. I have learned over the years that patients really want—but that they don't know to ask for—good distance vision. That knowl- edge has changed my way of thinking. Now, rather than concentrating on just good near vision, I concentrate on good distance vision. I believe that patients' second priority is good arm's length or intermediate vision. I tell patients that I can give them really good distance vision without glasses and that I can extend that dis- tance vision into a range to help them manage most of their important daily activities that are done at arm's length, such as see- ing the dashboard of your car or seeing the food on your plate. Patients also have some near vision. My patients report that they sometimes need a pair of reading glasses for regu- lar-sized or small print, or if they read for long periods of time. Dr. Weaver: The main goal of surgery is to remove the cataract, and my secondary goal is to decrease or elimi- nate glasses. There is never a guarantee that a patient will be spectacle-free, so we need to set that expectation correctly. With ORA, there is a 98% chance that I hit my refractive target, which decreases my patients' need for glasses. There is now objective data on surgeons and their postoperative results. As far as expecta- tions, my favorite implant is ReSTOR +2.5 with ACTIVE- FOCUS. It is the only implant that I have used that has a central portion 100% dedi- cated towards distance. It is a unique hybrid-design IOL. Other premium implants compromise that center area, and the advantage of the ACTIVEFOCUS optic is that it has that "wow" factor by providing uncompro- mised distance vision. How- ever, I think it's important to set clear expectations with this implant. I tell patients to anticipate that they will need a +1.25 D reader if they want to see close up, but otherwise, from arm's length through infinity, my patients have reported that they see very well without needing glasses or contacts. Another option I use for the patient who wants a little more near is to undercor- rect the non-dominant eye by 0.50 D. Dr. Hammond: The key to success with any lens choice is setting patient expecta- tions. I tell patients right up front that they should expect really good, nice, sharp, clear distance vision and good computer vision. They will need to wear a pair of low-power readers. For the most part, they should have great distance vision and really good com- puter vision. continued on page 6 Matt Hammond, MD, is in practice at the Logan Eye Institute in Logan, Utah. He can be reached at gr8vsn@yahoo.com. Tony Weaver, MD, is in practice at Eye Associates of Tallahassee. He can be reached at tweave@eyeassociates-tlh. com. Steve Scoper, MD, is in practice at Virginia Eye Consultants in Norfolk. He can be reached at sscoper@vec2020.com. Drs. Hammond, Scoper, and Weaver are consultants for Al- con and received compensation for their contributions to this supplement. Please see page 8 for Important Product Information.

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