Letters

New Resource Helps Surgeons to Master Premium IOLs

To the editor:

Ophthalmology is entering an exciting new era. The technology is rapidly changing, the boundaries of our capabilities are expanding, and today every cataract patient can expect to receive an intraocular lens that will not only replace his or her natural failing lens, but will, in the vast majority of cases, function safely and at a better optical level than the lens of a "normal" phakic individual of the same age.

Four or five decades ago, the goal was to restore useful vision after cataract removal without resorting to thick cataract spectacles; today, we are able to provide clarity of vision unequaled even by the natural lens. The rapidly developing field of IOLs began with correction of basic power; then, aided by corneal surgery, astigmatism was conquered. Now a new frontier — presbyopia — has been targeted in a new book, "Mastering Refractive IOLs, The Art And The Science" (Slack, Inc., 2008). I'd like to take this opportunity to offer a brief review of this enlightening text.

One Size Does Not Fit All

In this book, which contains contributions from over 200 experts, David Chang, M.D., and associate editors, Drs. Steven Dell, Warren Hill, Richard Lindstrom and Kevin Waltz, have provided a com prehensive textbook on the art and science of refractive IOLs for the practicing ophthalmologist.

This new technology will continue to improve, and with it we share the joy, the excitement and the sheer exhilaration of restoring sight to those who have not been able to see the world clearly. The premium, presbyopia-correcting IOL offers a restoration of vision to pre-presbyopic levels with "better than ever" clarity.

Covering everything from patient selection and education to management of complications, the book begins with the question, "Why offer premium IOLs?" In this section, 19 authors share their experiences and explain why they have transitioned from monofocal to premium, presbyopia-correcting IOLs. Other experts then explain how to select the best IOL for patient needs.

Three things determine the outcome, according to the authors: (1) the patient potential, i.e., the visual need and the health of the eye, (2) the technology and (3) the skill and mindset of the surgeon. The technology should be determined for the eye, not the eye for the technology. Premium IOLs are not "one size fits all." The lens should be chosen to meet the patient's needs and expectations.

It has been said that one who has a watch knows what time it is. If he has two watches, he is never sure. Optical characteristics of presbyopia-correcting lenses vary considerably, and the patient's visual needs factor significantly in the decision of which lens to offer each patient. Each of these lenses has a unique combination of advantages and disadvantages.

Patients are much more interested in the visual outcome than a particular technology, so the surgeon needs to make decisions that will meet their needs without confusing them with choices that only a scientist can understand. They are more interested in what you tell them about how they will be able to see.

Preoperative education and counseling is critical for success with any presbyopic IOL. Some lessons are clear. One should never promise the patient that he or she won't need glasses again; rather, mention there will be a need for glasses "at least some of the time." Then, if the patient does indeed need glasses on occasion, you have prepared him and he is satisfied. But if glasses are not needed, you are a hero.

That we have no universally perfect solution increases the importance of careful patient selection. The premium IOL appropriately allows surgeons to differentiate between refractive surgical goals. Understanding the differences between the available presbyopia IOL designs permits us as surgeons to individualize our approach, which for some patients may include mixing different lenses.

I encourage any serious practitioner of refractive eye surgeon to read this book to gain solid instruction in the use of presbyopia-correcting premium IOLs.

(Editor's note: Dr. Chang's book was also featured as the lead article in the "At Press Time" section of the June issue of Ophthalmology Management.)

Spencer P. Thornton, M.D., F.A.C.S.
Clinical Professor of Ophthalmology
Department of Ophthalmology
University of Tennessee Health Science Center
Memphis, Tenn.