Insight, The Journal of ASORN ASORN Insight 2018 Q3 - Page 33

EYE WONDER OD and βˆ’6.25 + 0.75 x 95 = 20/30+1 OS. Symfony lenses were implanted, targeting distance in the dominant eye and βˆ’0.50 in the nondominant eye. The patient wanted surgery in her nondomi- nant left eye first to see if night vision disturbances would be acceptable. Surgery consisted of insertion of the 13.5 D ZXR00 (nontoric Symfony) Figure 2. Patient’s drawing of halos after implantation of a multifocal IOL. discomfort. This is easily assessed by physician expectations of clear, high- holding a correcting minus lens in front quality vision and increased depth of of the near eye: the patient will immedi- focus? No, but we are getting closer. ately notice greatly improved quality of There is a new generation of IOLs that vision and the necessary correction will provide better quality of vision, less be apparent. glare, good intermediate vision, and occasionally good near vision. Multifocal IOLs Multifocal IOLs, still a popular option in the United States, are indicated in patients with healthy eyes who are highly motivated to be spectacle inde- pendent. With multifocal IOLs, diffrac- tive optics (which appear as rings on the IOL) divide the light into distance and near focal points; approximately 18% of the light is focused elsewhere (see Figure 1). Poor candidates include patients who demand perfect vision or are averse to halos, patients who have any sight-threatening ocular pathology, and myopic individuals who are used to superb uncorrected near vision. Multifo- cal IOLs have be •Έ±…ɝ•±δ…‰…Ή‘½Ή•)₯ΈΥΙ½Α”₯Έ™…ٽȁ½˜•αΡ•Ή‘•‘•ΑΡ ½˜)™½Ύ%=1́…ΉΡΙ₯™½…°%=1ΜΈ)5Υ±Ρ₯™½…°%=1́½™™•ΘΡ‘”Α½Ρ•ΉΡ₯…°™½Θ)ΝΑ•Ρ…±”΅™Ι•”Ω₯Ν₯½Έ°‰ΥЁё”±₯΅₯Ρ…Ρ₯½ΉΜ)…Ι”„Ν±₯‘Ёɕ‘ՍΡ₯½Έ₯ΈΩ₯ΝΥ…°ΕΥ…°΄)₯Ρ䰁‘…±½Μ…ЁΉ₯‘Π€‘Ν•”₯ΥΙ”€Θ€°…Ή)₯Ή…‰₯±₯ΡδΡΌ•±₯΅₯Ή…Ρ”Ρ‘•Ν”ΑΙ½‰±•΅Μέ₯Ρ )ΝΑ•Ρ…±”½ΙΙ•Ρ₯½ΈΈ)αΡ•Ή‘•‘•ΑΡ ½˜™½ΥΜ€‘=€%=1Μ)ΥΝ”…‘Ι½΅…Ρ₯Œ‘₯™™Ι…Ρ₯Ω”Ρ•‘Ή½°΄)½δΡΌ•±½Ή…Ρ”Ρ‘”™½Ύ½˜Ρ‘”•ε”)…ΉΙ•‘Ս”‘Ι½΅…Ρ₯Œ…‰•ΙΙ…Ρ₯½ΈΈQ‘”)Ι•ΝձЁ₯́ΝΥΑ•ΙˆΕΥ…±₯Ρ䁽˜‘₯ΝΡ…Ή”)Ω₯Ν₯½Έ°½½₯ΉΡ•Ι΅•‘₯…Ρ”Ω₯Ν₯½Έ°…Ή)‰•Ρѕȁѽ±•Ι…Ή”ΡΌ…ΝΡ₯΅…Ρ₯Ν΄Ρ‘…Έ)ΝΡ…Ή‘…ɐ΅Υ±Ρ₯™½…°%=1ΜΈ±Ρ‘½Υ )Ν½΅”=Α…Ρ₯•ΉΡ́½‰Ρ…₯Έ½½Ή•…Θ)Ω₯Ν₯½Έ°΅½ΝЁɕΕΥ₯Ι”±½ά΅…‘Ι•…‘•Ί™½Θ)‘•Ρ…₯±•Ή•…ȁх̸ͭ1₯­”…±°%=1Μ°=)%=1́ΝΑ±₯Ё±₯‘Π°…ΉΡ‘₯́Ι•…ѕ́Ω₯ΝΥ…°)‘₯ΝΡΥΙ‰…Ή•Μ°•ΝΑ•₯…±±δ…ЁΉ₯‘ΠΈ=)Α…Ρ₯•ΉΡ́ɕΑ½ΙЁё…Ёݑ•ΈΡ‘•δ±½½¬…Π)…ȁ‘•…‘±₯‘Ρ́…ЁΉ₯‘Π°Ρ‘•δΝ•”ΝΑ½­•Μ)½Θ„ΝΑ₯‘•Ιέ•ˆ…ΑΑ•…Ι…Ή”°έ‘•Ι•…Μ)΅Υ±Ρ₯™½…°%=0Α…Ρ₯•ΉΡ͕́”‘…±½ΜΈ)Q‘”½Ή±δ΅…ΑΑΙ½Ω•=%=0₯Έ)Ρ‘”UΉ₯Ρ•Mхѕ́₯́ё”Q•Ή₯́Mε΄΄)™½Ήδ€‘)½‘ΉΝ½Έ€˜)½‘ΉΝ½ΈY₯Ν₯½ΈμΝ•”)₯ΥΙ”€Μ€Έ%ΈΥΙ½Α”°Ρ‘”P1I™Ι½΄) …Ι°i•₯Ν́5•‘₯Ρ•Œ₯́…±ΝΌ½΅΅•Ι₯…±±δ)…Ω…₯±…‰±”Έ=Ρ‘•Θ%=1́έ₯Ρ ½Ρ‘•Θ½ΑΡ₯…°)‘•Ν₯ΉΜ…Ι”₯Έ±₯Ή₯…°ΡΙ₯…±ΜΈ)Q‘₯́…Ν”ΝΡՑ䁑•΅½ΉΝΡɅѕ́ΝՌ΄)αΡ•Ή‘••ΑΡ ½˜½Ύ…Ή)1½ά΅‘5Υ±Ρ₯™½…°%=1́•ΝΝ™Υ°ΥΝ”½˜=Ρ•‘Ή½±½δΈ₯Μ)Q‘”ΕΥ•ΝΡ₯½ΈΙ•΅…₯ΉΜθ%́ё•Ι”…Έ%=0‘•Θ™…΅₯±δ‰ΥΝ₯Ή•ΝΜΈAΙ•½Α•Ι…Ρ₯Ω•±δ°‘•Θ)Ρ‘…Ё™₯Ή…±±δ΅••Ρ́‰½Ρ Α…Ρ₯•ΉΠ…ΉΩ₯Ν₯½Έέ…ΜƒŠ"HΨΈΤΐ€¬€ΔΈΐΐΰ€Ψΐ€τ€ΘΐΌΜΐ₯Έ)„€Τΰ΅ε•…Θ΅½±™•΅…±”…ΡΡ½ΙΉ•δ½ <½˜)½΅‰₯Ή•έ₯Ρ ™•΅Ρ½Ν•½Ή₯ΉΡΙ…ΝΡΙΌ΄)΅…°Ι•±…α₯Ήœ₯Ή₯Ν₯½ΉΜΥΝ₯ΉœΡ‘” …Ρ…±εΜ)±…Ν•ΘΈA½ΝΡ½Α•Ι…Ρ₯Ω•±δ°U Yέ…Μ€ΘΐΌΜΐ°)(āέ₯Ρ „Ι•™Ι…Ρ₯½Έ½˜ƒŠ"HΐΈΤΐΝΑ‘•Ι”Έ)M‘”±½Ω•Ρ‘”Ω₯Ν₯½ΈΈ)M₯΅₯±…ȁΝΥɝ•Ιδέ…́Α•Ι™½Ι΅•™½ΘΡ‘”)Ι₯‘Ё•ε”έ₯Ρ „Ρ…ɝ•Π½˜Α±…ΉΌΈA½ΝΠ΄)½Α•Ι…Ρ₯Ω•±δ°U Yέ…Μ€ΘΐΌΘΐ°(āέ₯Ρ )„Ι•™Ι…Ρ₯½Έ½˜ƒŠLΐΈΘԁΝΑ‘•Ι”Έ9½άΝ‘”)½Ή±δ½…Ν₯½Ή…±±δΉ••‘́ѼΥΝ”Ι•…‘₯Ήœ)±…Ν͕́…Ή₯́ёΙ₯±±•έ₯Ρ ‘•ΘΩ₯Ν₯½ΈΈ)Ή½Ρ‘•Θ%=0½ΑΡ₯½Έ…Ω…₯±…‰±”ΡΌΎ₯ΈΡ‘”)UΉ₯Ρ•Mхѕ́₯́ё”I•ΝѽȀȸԁ€‘Ν•”)₯ΥΙ”€Π€°έ‘₯ ₯́„±½ά΅…‘΅Υ±Ρ₯™½…°)Ρ‘…ЁΑΙ½Ω₯‘•ΜΙ•…Ё‘₯ΝΡ…Ή”…Ή½½)₯ΉΡ•Ι΅•‘₯…Ρ”Ω₯Ν₯½Έ₯Έ΅½ΝЁΑ…Ρ₯•ΉΡΜΈ)­•δ…‘Ω…ΉΡ…”₯́ё…Ё‘…±½ΜΡ•ΉΡΌ)‰”΅₯Ή₯΅…°Έ́έ₯Ρ ½Ρ‘•Θ%=1́₯ΈΡ‘₯Μ)…Ρ•½Ι䰁±½ά΅…‘Ι•…‘₯Ήœ±…Ν͕́…Ι”)ΥΝΥ…±±δΙ•ΕΥ₯Ι•™½ΘΉ•…ȁΩ₯Ν₯½Έ°…Ή)½Ή”…ΑΑΙ½… ΡΌ₯΅ΑΙ½Ω”Ή•…ȁΩ₯Ν₯½Έ₯Μ)ΝΌ΅…±±•΅₯Ι½΅½Ή½Ω₯Ν₯½Έθ…₯΅₯Ήœ™½Θ+Š"HΐΈΤΐΡΌƒŠ"HΐΈάԁ₯ΈΡ‘”Ή½Ή‘½΅₯Ή…ΉΠ•ε”Έ)Q‘”™½±±½έ₯Ήœ…Ν”ΝΡՑ䁅…₯Έ‘•΄΄)½ΉΝΡɅѕ́ΝՍ•ΝΝ™Υ°₯΅Α±•΅•ΉΡ…Ρ₯½Έ½˜)Ρ‘₯́ΝΡΙ…Ρ•δθ)ML₯́„€άΠ΅ε•…Θ΅½±½ΙΡ‘½Α•‘₯ŒΝΥɝ•½Έ)έ‘Όέ…́=L‘½΅₯Ή…ΉΠ…ΉΙ••₯Ω•)‰₯±…Ρ•Ι…°I•ΝΡ½Θ€ΘΈΧ %=1ΜΈQ‘”Ρ…ɝ•Π)™½ΘΡ‘”±•™Π•ε”°έ‘₯ έ…́½Α•Ι…Ρ•)™₯ΙΝΠ°έ…́‘₯ΝΡ…Ή”μΡ‘”Ρ…ɝ•Π™½ΘΡ‘”)Ι₯‘Ё•ε”έ…ΜƒŠ"HΐΈάΤΈ!₯́½Υэ½΅”έ…Μ)…́™½±±½έΜθ+Šˆ=Lθ€ΘΐΌΘΐ°(́έ₯Ρ Α±…ΉΌΙ•™Ι…Ρ₯½Έ)…Ή+Šˆ=θ€ΘΐΌΜΐ°(āέ₯Ρ ƒŠ"HΐΈάԁɕ™Ι…Ρ₯½ΈΈ)½ΉΡ₯ΉΥ•½ΈΡ‘”Ή•αЁΑ…”)M=I8%9M%!PMΥ΅΅•Θ€ΘΐΔΰ(ΜΔ