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Personal Experience on ReSTOR Multifocal Lens

Personal Experience on ReSTOR Multifocal Lens. 瑞光眼科　黃維仁醫師. Candidate for MF IOL. Dense cataract Hyperopia > High myopia > emmetropia low myopia Realistic expectation. High myopia patient Age, AX L macular function

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Personal Experience on ReSTOR Multifocal Lens

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  1. Personal Experience on ReSTOR Multifocal Lens 瑞光眼科　黃維仁醫師

  2. Candidate for MF IOL • Dense cataract • Hyperopia > High myopia > emmetropia low myopia • Realistic expectation

  3. High myopia patient Age, AXL macular function Age macular function AXL macular function AXL biometry accuracy AXL IOL decentration Special Consideration for Patient Selection

  4. Personal Contraindication • Unrealistic expectations • Monofocal IOL in fellow eye (good result) • Macular, optic nerve degeneration • Cornea problem • Decentered pupil, atonic pupil • Weak zonule

  5. Personal Strategy for Pre-op Consultation • General post-op visual phenomenon • Much added gain after 2nd eye operation • Use both eyes simultaneously for the best performance • OP interval: 2 weeks

  6. Personal Strategy for Operation • Non-dominant eye first • First eye target refraction +0.5 ~ +0.75 instead of 0 ~ +0.25 why ? • OP interval: 2 weeks ( for refraction stabilization) • Adjust 2nd eye target refraction based on first eye result

  7. Special Characters of S-P AcrySof • Optic glistening • Vulnerable optic : loading and implantation • Slow unfolding : IOL centration

  8. Optic glistening

  9. Optic Glistening • Material related, high refractive index acrylic • Temperature related • Alcon’s responsibility Don’t pre-heat the S-P AcrySof (3-P AcrySof with forceps)

  10. ReSTOR Loading and Implantation • Haptic damage : nearly never • Optic indentation mark : Greishaber forceps • Optic crack, scratch Loading procedure : plunger under optic (x) • Plastic strip on posterior surface of optic • Any resistance, stop injection

  11. Cartridge Strip

  12. IOL Centration in ReSTOR • Pre-op evaluation • IOL loading procedures • Intra-op procedures and post-op management

  13. IOL Centration in ReSTOR Pre-op Evaluation • Pupil condition • Zonule condition • IOL-pupil unmatched Visual axis reference Argon laser pupilloplasty

  14. IOL Centration in ReSTOR Intraoperation Procedures & Post-op Management • CCC is the most important factor • Small CCC : intraoperative capsuloplasty Postoperative YAG capsuloplasty • Asymmetrical large CCC Anterior capsule cleaning Postoperative YAG capsuloplasty • Teared CCC : regain symmetricity

  15. IOL Centration in ReSTOR Intraoperation Procedures & Post-op Management • Slow unfolding of optic and haptic • Leading haptic under optic : cautious • Remained cortex and vitreous strand : cautious • Be careful not to push out the haptic from bag during viscoelastic removal • Center well if once center well

  16. IOL Centration in S-P AcrySof

  17. Reading Ability and Pupil Diameter • Pupil independent in diffrative MFIOL ? • Pupil diameter reading ability in ReSTOR

  18. “Apodized” Diffractive Optic 1.3 micron step 0.75mm 1.5 mm

  19. 1 0.9 0.8 0.7 0.6 Relative Energy Distance Focus 0.5 Near Focus 0.4 0.3 0.2 0.1 0 1 2 3 4 5 6 Pupil Diameter (mm) Theoretical Total Energy Balance at 550 nm for ReSTOR “Apodized” Diffractive Optic Grossly magnified schematic. Larger steps at lens center divide light equally between two images Smaller steps further out direct less light to near

  20. 20/16 20/20 70 cm 60 cm 50 cm 20/25 20/32 20/40 20/50 20/63 20/80 20/100 20/125 20/160 20/200 How does this compare to a Monofocal ?

  21. PCO in ReSTOR • Visual impaction more than expected • Post capsule cleaning routinely • Thinner IOL and no-vaulting degree • Early YAG capsulotomy is indicated if necessary

  22. Postoperative Consultation • Visual phenomenon will subside with time • Good far vision, poor near vision check reading distance (esp. for mod-high myopia) check pupil diameter • Poor far vision, poor near vision check cornea (dry eye, astigmatism) check PCO, PC striae check fovea (CME)

  23. Postoperative Refraction Correction • PRK : wound healing in old patient • LASIK : pre-op flap post-op flap • Piggyback IOL Silicone or Acrylic Interlenticular opacity Two in bag? One in bag, one in Sulcus?

  24. Achieve the Best Result of MFIOL • Patient selection • Pre-op counseling • Intra-op procedures : CCC • Post-op follow-up : CCC-IOL condition, cornea epith, post capsule, CME • Fine tuning if necessary (sph. cyl.) • Post-op counseling

  25. Thanks for your attention!

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