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Presbyopia Correction: Exploring Surgical Eyeworld January 2017 Eyeworld September 2016 Options, Expectations, and Postoperative Error

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Presbyopia Correction: Exploring Surgical Eyeworld January 2017 Eyeworld September 2016 Options, Expectations, and Postoperative Error Presbyopia 365 Curriculum Presbyopia correction: Exploring surgical EyeWorld January 2017 EyeWorld September 2016 options, expectations, and postoperative error Describing the stages of presbyopia: Understanding its onset and progression by Daniel Durrie, MD their colleagues and patients about the normal phases of crystalline lens change that With new diagnostic tools, occur with aging. When we “ review the stages of dysfunc- we can show patients the tional lens syndrome (DLS), we not only describe the way color, appearance, and density the lens changes but can correlate these changes with of the lens and how they treatments that are most ap- affect vision. propriate at each stage.1,2 ” –Daniel Durrie, MD Illustrative analogy During human embryon- New terminology ic development, a piece of When we explain this to ectodermal tissue splits off to DLS stages gains momentum in our patients, they understand Patients usually enter stage become the crystalline lens. ophthalmic practices it well. Previously, patients 1 of DLS at an average age of Consequently, it ages simi- knew their eyes changed 43. In stage 1, the lens is clear larly to the skin. As disulfide new three-stage during middle age and that and colorless, but the lens los- bonds accumulate inside the classification cataracts may develop later, es the ability to change power. lens through all three stages, system is helping but no one explained how the As a result, most patients have the lens loses flexibility and cataract surgeons lens was changing. density increases. A communicate with continued on page 2 Accreditation Statement Designation Statement Food and Drug Administration (FDA) or have Rosa Braga-Mele, MD, FRCSC, is a member This activity has been planned and imple- The American Society of Cataract and been approved by the FDA for specific uses of the speakers bureaus of Alcon Laborato- mented in accordance with the accreditation Refractive Surgery designates this enduring only. ries and Allergan. requirements and policies of the Accredi- materials educational activity for a maximum Daniel Chang, MD, has an investment inter- tation Council for Continuing Medical Edu- of 1.0 AMA PRA Category 1 Credits.™ Physi- ADA/Special Accommodations est in Omega Ophthalmics. He has received cation through the joint providership of the cians should claim only credit commensurate ASCRS and EyeWorld fully comply with the a retainer, ad hoc fees, or other consulting American Society of Cataract and Refractive with the extent of their participation in the legal requirements of the Americans with income from: Abbott Medical Optics, Allergan, Surgery (ASCRS) and EyeWorld. ASCRS is ac- activity. Disabilities Act (ADA) and the rules and Carl Zeiss Meditec, Mynosys Cellular Devices, credited by the ACCME to provide continuing regulations thereof. Any participant in this and Omega Ophthalmics. Dr. Chang has medical education for physicians. Claiming Credit educational program who requires special received expense reimbursement from and is To claim credit, participants must visit accommodations or services should contact a member of the speakers bureaus of Abbott Educational Objectives bit.ly/2gVjCDk to review content and down- Laura Johnson at [email protected] or Medical Optics and Carl Zeiss Meditec. He Ophthalmologists who participate in this load the post-activity test and credit claim. All 703-591-2220. has received research funding from Abbott activity will: participants must pass the post-activity test Medical Optics and Mynosys Cellular Devices. • Accurately describe the progressive with a score of 75% or higher to earn credit. Financial Interest Disclosures Daniel Durrie, MD, has an investment inter- diagnosis of presbyopia and the optical Alternatively, the post-test form included in John Berdahl, MD, has earned a royalty est in, has received expense reimbursement fundamentals of correction options, uti- this supplement may be faxed to the number or derived other financial gain from from, and has received a retainer, ad hoc fees lizing the appropriate current terminology indicated for credit to be awarded, and a Imprimis and Ocular Surgical Data. He has or other consulting income from AcuFocus, of presbyopia to describe all stages of the certificate will be mailed within 2 weeks. an investment interest in DigiSight, Omega Alphaeon, and Strathspey Crown. He has disease state When viewing online or downloading the ma- Ophthalmics, and Vision 5. Dr. Berdahl has received research funding from AcuFocus, • Compare and contrast presbyopia terial, standard internet access is required. received a retainer, ad hoc fees or other con- Alcon, Allergan, Avedro, and EyeGate Pharma. treatment options to match solutions to Adobe Acrobat Reader is needed to view the sulting income from: Abbott Medical Optics, Dr. Durrie has received expense reimburse- patients’ needs, and describe range of materials. CME credit is valid through June Alcon Laboratories, Avedro, Bausch + Lomb, ment from Avedro and Hoopes Durrie Rivera vision functions as related to patients’ 30, 2017. CME credit will not be awarded Calhoun Vision, ClarVista, DigiSight, Enviseo, Research. needs after that date. Glaukos, Imprimis, Ocular Therapeutix, Staff members: Kristen Covington and Laura • Implement a lower threshold for accept- Omega Ophthalmics, Ocular Surgical Data, Johnson have no ophthalmic-related financial able pseudophakic refractive error levels Notice of Off-Label Use Presentations Vision 5, and Vittamed. He is a member of interests. in presbyopia-corrected patients, and This activity may include presentations on the speakers bureaus of Glaukos and Ocular Supported by an unrestricted identify steps to mitigate refractive sur- drugs or devices or uses of drugs or devices Therapeutix. educational grant from Abbott prises and other key variables to increase that may not have been approved by the postoperative success Medical Optics 2 3 Presbyopia correction: Exploring surgical options, expectations, and postoperative error continued from page 1 23-year-old lens 48-year-old lens 55-year-old lens Stage 1 DLS Stage 2 DLS Figure 1. The first two stages of dysfunctional lens syndrome difficulty reading up close, significant change in corne- In stage 3, which usually Optometrists frequently while a minority may struggle al curvature from refractive occurs at an average age of 73, appreciate this tool when with distance vision, depend- surgery. patients have a cataract. The explaining lens changes to ing on which layers in the Stage 2 occurs in patients only treatment at this stage patients. lens change. in their 50s and 60s, when is lens replacement, which is Three surgical presby- the lens becomes yellow and covered by insurance once a References opia-correcting options are slightly clouded, with high- cataract has been diagnosed. 1. Durrie DS. Dysfunctional lens available during this stage. er-order aberrations. Patients syndrome. 2016 American Academy Blended vision or monovision require more light to read, Diagnostic technology of Ophthalmology annual meeting, LASIK has been the standard. and their night vision is not With new diagnostic tools, we Chicago. If a patient is a good LASIK as good. can show patients the color, 2. Waring GO IV, et al. Use of dysfunc- candidate, correcting the When I explain this stage appearance, and density of tional lens syndrome grading to guide dominant eye for plano and to patients, they often smile the lens and how they affect decision making in the surgical cor- the non-dominant eye for and nod, reassured to know vision. We take a slit lamp rection of presbyopia. 2016 ASCRS• –1.0 to –1.25 D has achieved DLS is a normal process and photograph of the lens and ASOA Symposium & Congress, New satisfactory results. Almost why it is occurring. perform a dilated examination Orleans. 100% of my presbyopic pa- In refractive practices, on a rotating Scheimpflug 3. Yılmaz OF, et al. Intracorneal inlay tients with myopia, moderate the most common stage 2 camera system for anterior to correct presbyopia: long-term hyperopia, or astigmatism treatment is RLE because segment analysis. This shows results. J Cataract Refract Surg. who plan to have LASIK to the patient’s optical quality lens density changes. 2011;37:1275–1281. achieve spectacle indepen- has decreased. We can still We also use an optical 4. Whitman J, et al. Through-fo- dence choose this option. perform LASIK monovision or quality analysis system, which cus performance with a corneal In addition, two corneal blended vision, but patients provides the optical scatter in- shape-changing inlay: one-year inlays have been approved need to know it will not last dex, demonstrating decreased results. J Cataract Refract Surg. by the U.S. Food and Drug long term and they eventually vision quality.5 2016;42:965–971. Administration to treat pres- will require lens replacement. 5. Cochener B, et al. Correlational byopia.3,4 They are designed At this stage, optical Conclusion analysis of objective and subjective for patients who still have a quality is no longer adequate Anyone can use DLS terminol- measures of cataract quantification.J clear lens. for corneal inlays. However, ogy to describe lens changes Refract Surg. 2016;32:104–109. If patients in stage 1 have we can perform RLE without and available treatment op- +3.0 D or greater hyperopia, removing inlays from patients tions. However, all clinicians Dr. Durrie is founder of Durrie most surgeons consider refrac- who have them. Following and staff in a practice need to Vision and the Durrie Vision tive lens exchange (RLE) in patients 10 years after inlay be trained about these stages Research Center, Overland Park, this age group. If we perform procedures, I have found that to ensure that everyone is Kansas, and clinical professor LASIK on a patient with +4.0 they still have good vision, using the same language. of ophthalmology, University hyperopia, years later cat- but eventually we will need to Practices should share of Kansas, Overland Park. He aract surgery may be more replace their lenses. this information with their can be contacted at Ddurrie@ complicated because of the optometric referral networks.
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