Getting the Most out of Three IOLs

Posted on February 22, 2013 by Laser Locators

“The aspheric design of this multifocal IOL enhances patients’ outcomes”, says Elizabeth A. Davis, MD. “There are a number of different IOLs to choose from to achieve the best outcome for patients today. Presbyopic correction lenses are now available and with good results. In many cases, surgeons prefer the Tecnis Multifocal IOL (Abbott Medical Optics Inc. [AMO]) based on their design and positive outcomes.”

In assessing any IOL, you must consider several factors: ease of implantation, predictability of refractive outcome, quality of vision, range of focus (spectacle independence), patients’ satisfaction, side effects, and long-term stability.

The Tecnis Multifocal IOL is based on an aspheric optic design meant to reduce the spherical aberration of an average cornea to zero. The Tecnis Multifocal has a full-diffractive posterior surface, which makes the diffractive optics pupil independent for optimal image quality at all distances under any lighting condition. The optic is made of acrylic and comes in both a one- and three-piece design. The frosted edge also minimizes edge glare.

Experience With The Lens

In a clinical trial, 94.6{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of subjects implanted bilaterally with the lens reported being satisfied with their vision. Also at 1 year, 92.1{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of the subjects had 20/25 or better distance UCVA and saw 20/32 or better at near with distance correction in place. More than 86{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of subjects reported never wearing glasses, and slightly less than 90{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} were able to function comfortably without glasses at all distances (96.9{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} at near, 89.7{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} at intermediate, and 95.5{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} at distance).Only 1{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} always wore glasses.

All multifocal IOLs inherently reduce contrast and induce some amount of glare and halos, it is important to inform all patients that they should anticipate such side effects. Achieving optimal refractive outcomes with the Tecnis Multifocal IOL requires careful preoperative, intraoperative, and postoperative care. Preoperative preparation requires optimization of the ocular surface, a thorough examination to exclude patients with conditions that would preclude good outcomes, and precise biometry and IOL calculations.

To achieve the best results with the lens, it is important to choose appropriate candidates. Certainly, patients should desire reduced dependence on glasses and contact lenses. They should understand not only the risks of cataract surgery in general but the potential side effects of the lens, including reduced contrast, glare, and halos. Either patients should have minimal corneal astigmatism, or the surgeon should have an appropriate method to manage astigmatism. Accurate preoperative keratometric and biometric measurements are critical, and ocular surface disease must be aggressively treated.

Presbyopia-correcting IOLs are one of the most important transforming factors in the practice of anterior segment ophthalmology, and the AcrySof IQ Restor (Alcon Laboratories, Inc.) diffractive multifocal lens is the most commonly implanted presbyopia-correcting IOL in the United States. This technology offers patients visual rehabilitation for functional distance, reading, and intermediate vision. The surgeon’s selection of patients, meticulous attention to detail, and optimization of postoperative results are the keys to successful outcomes with this lens.

Recent advances in technology with laser cataract surgery may permit greater centration and consistent sizing of the capsulorhexis that could enhance refractive outcomes with presbyopia-correcting IOLs. Accurate biometry with the IOLMaster (Carl Zeiss Meditec, Inc.) or the Lenstar LS 900 (Haag-Streit AG) and control of astigmatism are also essential to maximizing outcomes. Because the lens constant must be carefully personalized to the individual surgeon, tracking postoperative results is imperative to refine surgical outcomes.

Patients are incredibly sensitive to small refractive errors with presbyopia-correcting IOLs, so surgeons must be willing and able to treat them. Astigmatism of greater than 0.50 D in a symptomatic patient requires surgical planning.

With attention to residual refractive error, the ocular surface,2 cystoid macular edema, and the posterior capsule, surgeons can improve appropriate patients’ quality of vision with the AcrySof IQ Restor IOL. The technology has enhanced the quality of life of many pseudophakic patients by reducing or eliminating their need for spectacles. As physicians’ comfort with multifocal lenses improves in the coming years, these IOLs should become more popular, both with cataract and refractive surgeons and their patients.

At Laser Locators we carry the top name surgical and diagnostic ophthalmic equipment manufacturers you can trust, like Acon, Nidek, Lumenis and more for preforming all of your precise ophthalmic procedures. Contact us at www.laserlocators.com or call 1-877-924-2020 and let one of our expert equipment locators help you today.

OCT – Now A Tool For The Comprehensive Ophthalmologist

Posted on January 30, 2013 by Laser Locators

Ocular Surgery News U.S. Edition, June 10, 2012

According to Richard L. Lindstrom, MD optical coherence tomography has moved from being a tool primarily utilized by the retina subspecialist to one increasingly present in the comprehensive ophthalmologist’s office.

Time-domain OCT (TD-OCT) is a non-contact test that can be done by an ophthalmic technician to image the optic nerve, macula or retina. The OCT (SD-OCT), which is a higher-speed, higher-definition instrument that gives even better images, allowing resolution that includes individual cell layers including the retinal pigment epithelium (RPE), photoreceptors, as well as a larger area of the retina or macula. The newest SD-OCT algorithms even allow 3-D reconstructions.

New strides are occurring in TD-OCT and SD-OCT to interpret retinal and macular thickness, RPE elevation and drusen size/volume in microns. In the future, it is anticipated that even cellular metabolic rates will be measurable. And similar technology is being applied in the anterior segment, promising great advances in diagnostic capability.

The classical abnormalities in dry age–related macular degeneration include drusen formation, pigment dispersion/clumping and focal atrophy of the RPE. Each of these findings can be observed, documented and measured with OCT. In addition, with SD-OCT, drusen size and volume can be measured, and the actual RPE cells at the edge of an area of geographic atrophy can be seen, allowing one to measure the rate of progression. Photoreceptor atrophy and changes in the choriocapillaris often accompany these changes and can be visualized. In wet AMD, one can visualize the area where abnormal vessels penetrate Bruch’s membrane, causing fluid or blood to accumulate under the RPE and resulting in a pigment epithelial detachment (PED) or fluid accumulation in the subretinal space or within the retina. The size and volume of a PED can be measured, as can the overlying retinal thickness, potentially allowing earlier diagnosis and, when treated, monitoring of the response to therapy.

For the cataract surgeon, preoperative screening allows the detection of epiretinal membranes, vitreomacular traction syndrome, diabetic macular edema and rarer macular abnormalities such as macular schisis, resulting in proper preoperative, intraoperative and postoperative therapy and timely patient counseling. Postoperative macular thickness is a very useful tool in the diagnosis of postsurgical cystoid macular edema and is also helpful in monitoring the response to therapy. TD-OCT imaging and SD-OCT imaging of the optic nerve head are becoming a critical component in the early diagnosis of glaucoma and in monitoring the patient for early signs of progression.

Ophthalmology has always been heavily dependent on technology to enhance the diagnostic and treatment acumen of the clinician, and despite the cost of OCT acquisition in the face of increasing economic pressure; it is difficult to imagine a busy ophthalmic practice without OCT or SD-OCT in 5 years.

Global Ophthalmic Diagnostic Equipment Market Forecast To Grow

The global ophthalmic diagnostic equipment market was estimated at $715.4 million in 2010 and is forecast to grow at a Compound Annual Growth Rate (CAGR) of 4{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} to reach $947 million by 2017. The ophthalmic diagnostic equipment market includes perimeters, automatic and manual refractors, slit lamps, contact and non-contact tonometers, fundus cameras, automatic and manual lens meters, direct and indirect ophthalmoscopes, ultrasound equipment, corneal topography systems and other imaging systems. Technological innovations are stimulating growth in this otherwise saturated market dominated by traditional products. Recent advances in Optical Coherence Tomography (OCT) systems have contributed to the renewed market growth.

The market for ophthalmic diagnostic equipment is growing due to a significant increase in the incidence and prevalence of eye related disorders among the elderly population and the availability of reimbursement for eye care screening in the majority of developed economies. With the introduction of ophthalmic diagnostic equipment with advanced technologies there is an increased interest in the prevention of blindness caused by Diabetic Retinopathy (DR), glaucoma, and macular degeneration. Thus, people are increasingly opting for diagnostic measures to correct eye related disorders.

Old age is associated with certain problems, especially the degeneration of visual abilities. By 2025, people aged 60 and above will constitute 35{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of the total global population. Thus, with an increase in the elderly population, demand for products related to eye disorders will increase. Moreover, developing regions in Asia and South and Central America will provide growth opportunities as these markets are unsaturated. More than half of the global population resides in Asia, with India and China accounting for over 50{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of the regional population. This offers significant market opportunities for manufacturers of ophthalmic diagnostic equipment.