A quick list of considerations for maximizing the success of Presbyopia-correcting intraocular lenses.
Goal: Happy patient
Preoperative:
- Select appropriate candidates
- Patients should have realistic expectations
- Patients should not have ocular disease that compromises IOL function
- Customize lens choice depending on patient’s lifestyle and visual needs. Consider mixing/matching IOL designs.
- Counsel patients regarding glare/halo, dysphotopsia, and need for enhancement
- Treat ocular surface disease (i.e., dry eye, MGD) aggressively
- Additional testing (ocular dominance, pupil size, Lissamine green, corneal topography, macular OCT, visual fields)
- Accurate biometry (i.e., IOLMaster 500 and LENSTAR LS 900 using appropriate IOL calculation formulas (optimized, newer generation))
- Target emmetropia
- Consider mini-monovision for Crystalens patients
- When feasible operate on non-dominant eye first
- Pre-treat with antibiotic and NSAID 1-3 days prior to surgery
Intraoperative:
- Meticulous surgical technique
- Appropriately sized, shaped, and centered capsulotomy
- Remove all subincisional cortex and polish capsule
- Watertight incisions
- Confirm IOL centration
- Reduce/eliminate astigmatism
- Consider wavefront aberrometry for astigmatism correction and aphakic lens power measurement
Postoperative:
- Medications
- Antibiotic for 1-2 weeks
- NSAID and steroid for 4-8 weeks depending on risk of CME. I favor Besivance, Bromday, and Lotemax gel. Consider Durezol for patients with more corneal edema and intraocular inflammation. Beware generic medications, which may be less potent as well as more toxic to the cornea.
- Promptly address patient concerns
- Treat ocular surface disease
- Diagnose and treat CME and PCO early. Mild PCO can significantly impact vision in patients with presbyopia-correcting IOLs.