Eyeworld CME Supplements

EW_JAN 2017_Supported by an unrestricted educational grant from Abbott Medical Optics

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2 Presbyopia correction: Exploring surgical options, expectations, and postoperative error difficulty reading up close, while a minority may struggle with distance vision, depend- ing on which layers in the lens change. Three surgical presby- opia-correcting options are available during this stage. Blended vision or monovision LASIK has been the standard. If a patient is a good LASIK candidate, correcting the dominant eye for plano and the non-dominant eye for –1.0 to –1.25 D has achieved satisfactory results. Almost 100% of my presbyopic pa- tients with myopia, moderate hyperopia, or astigmatism who plan to have LASIK to achieve spectacle indepen- dence choose this option. In addition, two corneal inlays have been approved by the U.S. Food and Drug Administration to treat pres- byopia. 3,4 They are designed for patients who still have a clear lens. If patients in stage 1 have +3.0 D or greater hyperopia, most surgeons consider refrac- tive lens exchange (RLE) in this age group. If we perform LASIK on a patient with +4.0 hyperopia, years later cat- aract surgery may be more complicated because of the significant change in corne- al curvature from refractive surgery. Stage 2 occurs in patients in their 50s and 60s, when the lens becomes yellow and slightly clouded, with high- er-order aberrations. Patients require more light to read, and their night vision is not as good. When I explain this stage to patients, they often smile and nod, reassured to know DLS is a normal process and why it is occurring. In refractive practices, the most common stage 2 treatment is RLE because the patient's optical quality has decreased. We can still perform LASIK monovision or blended vision, but patients need to know it will not last long term and they eventually will require lens replacement. At this stage, optical quality is no longer adequate for corneal inlays. However, we can perform RLE without removing inlays from patients who have them. Following patients 10 years after inlay procedures, I have found that they still have good vision, but eventually we will need to replace their lenses. In stage 3, which usually occurs at an average age of 73, patients have a cataract. The only treatment at this stage is lens replacement, which is covered by insurance once a cataract has been diagnosed. Diagnostic technology With new diagnostic tools, we can show patients the color, appearance, and density of the lens and how they affect vision. We take a slit lamp photograph of the lens and perform a dilated examination on a rotating Scheimpflug camera system for anterior segment analysis. This shows lens density changes. We also use an optical quality analysis system, which provides the optical scatter in- dex, demonstrating decreased vision quality. 5 Conclusion Anyone can use DLS terminol- ogy to describe lens changes and available treatment op- tions. However, all clinicians and staff in a practice need to be trained about these stages to ensure that everyone is using the same language. Practices should share this information with their optometric referral networks. Optometrists frequently appreciate this tool when explaining lens changes to patients. References 1. Durrie DS. Dysfunctional lens syndrome. 2016 American Academy of Ophthalmology annual meeting, Chicago. 2. Waring GO IV, et al. Use of dysfunc- tional lens syndrome grading to guide decision making in the surgical cor- rection of presbyopia. 2016 ASCRS• ASOA Symposium & Congress, New Orleans. 3. Yılmaz OF, et al. Intracorneal inlay to correct presbyopia: long-term results. J Cataract Refract Surg. 2011;37:1275–1281. 4. Whitman J, et al. Through-fo- cus performance with a corneal shape-changing inlay: one-year results. J Cataract Refract Surg. 2016;42:965–971. 5. Cochener B, et al. Correlational analysis of objective and subjective measures of cataract quantification. J Refract Surg. 2016;32:104–109. Dr. Durrie is founder of Durrie Vision and the Durrie Vision Research Center, Overland Park, Kansas, and clinical professor of ophthalmology, University of Kansas, Overland Park. He can be contacted at Ddurrie@ Durrievision.com. continued from page 1 Figure 1. The first two stages of dysfunctional lens syndrome 23-year-old lens 48-year-old lens Stage 1 DLS 55-year-old lens Stage 2 DLS

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