Lenticular surgery options expand

Key Points

Minneapolis-Options for presbyopia-correcting lenticular surgery continue to expand. Newer technology is providing better-quality outcomes that also are fueling more widespread use of this implant technology, said Richard L. Lindstrom, MD.

"Overall, IOL surgery for treating presbyopia is becoming a more important area so that anterior segment surgeons should be equipped with the necessary skills," said Dr. Lindstrom, founder and attending surgeon, Minnesota Eye Consultants and adjunct professor emeritus, department of ophthalmology, University of Minnesota, Minneapolis.

Monovision currently is the most widely used among presbyopia-correcting lenticular surgery approaches. For this technique, Dr. Lindstrom said he favors aspheric IOLs and aims for a target refraction of plano to –0.5 D for the distance eye and –1.25 to –1.75 D for the near eye. He begins by operating on the eye with the worse cataract first and targets that for distance.

"It is sometimes recommended that the dominant eye be the distance eye, but I have found most patients adapt well regardless of whether the dominant eye is treated for near or distance," he said.

Dr. Lindstrom said he has not found a contact lens trial predictive of success or practical since, according to the literature, the trial duration should be at least 3 months. Problems that can be encountered with lenticular monovision include reduced binocular summation, reduced stereopsis, and anisokonia. In addition, about 5% to 10% of patients do not neuroadapt.

"If problems persist, patients can undergo an excimer laser ablation, treating both eyes for distance, or if the patients prefer, both eyes for near," Dr. Lindstrom said.