Full Range of Vision IOLs for Patients Wanting Spectacle Independence

Video content above is prompted by the following:Refractive Lens Exchange in Patient With Dry Eye

Key Discussion Topics

• Complex patient profile
  • A 57-year-old woman with Hashimoto thyroiditis and dry eye
  • Low hyperope with trace nuclear sclerosis (refractive lens exchange candidate)
  • Avid tennis player requiring good stereopsis
  • Contact lens intolerant with dependence on reading glasses over contacts
• Preoperative management
  • Preoperative optimization of ocular surface to improve topography
  • Inferior steepening on topography related to dry eye, not keratoconus
• Lens selection considerations
  • Monovision contraindicated due to tennis requiring stereopsis
  • Extended depth of focus lenses insufficient for patient’s reading needs
  • Consultation with Canadian colleagues regarding enVista intraocular lens (IOL) performance in patients with dry eye

Notable Insights and Outcomes

• Dell observed rapid visual recovery with enVista IOLs even in suboptimal corneal conditions
• Patient received a Toric enVista IOL (placed at axis 326°, 25°)
• On postoperative day 1, coinciding with a voluntary recall of the enVista IOL, patient reported excellent uncorrected distance and near vision
• At 1-week follow-up, patient remained satisfied despite the recall
• The subsequent reintroduction of enVista to the market allowed for potential matching IOL placement in the fellow eye

Concluding Observations

• Late laser vision correction enhancements remain complicated but increasingly important
• PRK is likely the best option for enhancement after laser vision correction, though still imperfect
• Modern IOL designs have made refractive precision critical in this demanding patient population