What I’ve learned
Since those initial cases, some changes have been implanted in how I plan for surgery and counsel patients.
1. Balance the refractive targets
Early cases, I targeted a slightly myopic outcome. I now aim for plano in both eyes, with the caveat of choosing the IOL power that is closest to plano on the plus side for the dominant eye and on the minus side for the non-dominant eye. In other words, if the IOL formula printout shows IOL power options that would provide either -0.09 D or +0.13 D, I would choose the latter if operating on the dominant eye and the former for the non-dominant eye.
2. Counsel adequately
It is not enough to tell patients they will have “functional near vision,” as this is not necessarily a term they recognize. I provide examples of what they probably will NOT be able to do with an EDOF lens (read a newspaper, read the back of pill bottles). I discuss the possibility of halos, starbursts, and glare, which—while much less likely than with multifocal IOLs—still may be noticeable to the discriminating patient.