I’m Spectacle Free Optometrist Experiences EDOF IOLs

My thought process, when deciding on this particular product, was informed in a few ways. I previously worked for a refractive surgeon, and saw the great results that multifocal implants were giving patients, particularly for hyperopic presbyopes, the category I fell into. At that time, the drawbacks with those designs were the ‘gaps’ or subtle jumps in vision when moving from one distance to another, and the issue of flare and glare around lights at night. However, the spectacle independence always outweighed those compromises.

Recommending surgery to patients in an optometric practice is easy, and… a professional obligation

Teleon’s Lentis Comfort EDOF IOL is made from a hydrophilic material, with a plate haptic design.

A friend of mine – an optometrist who works for a refractive surgeon and is of a similar age and refractive status to me – had recently undergone EDOF lens surgery. I spoke to him and he was thrilled at the outcome, so I took that as a very positive recommendation. I went in for a consult, and to my surprise, found out that I had early cataract development (like a lot of optometrists, I don’t get my eyes checked often enough!). This immediately justified my decision to choose surgery, and so I took my friend’s recommendation, knowing that if I gave it too much thought, I’d be pondering the ‘what ifs’ and delaying surgery in the hope of a new, better product around the corner, a similar situation to most technologies today, with mobile phones being a good example.

While I didn’t do too much technical research into EDOF lenses, I did know they have a maximum effective addition of +1.50, and on that basis, I asked the surgeon if he could aim to make me very mildly myopic in the distance, to the tune of -0.25 in both eyes, which would give me a slightly higher effective addition at near – I felt my distance acuity would not be affected. My primary visual requirement prior to surgery was near vision, and I was determined to have full spectacle independence. The surgeon had not had a request like this before, and was very interested to accommodate my request by working around to manipulate the refractive outcome.

EXPERIENCE IN SURGERY

My experience with the surgery was highly positive. Having previously told my surgeon I was somewhat apprehensive about the surgery, he agreed to a general anaesthetic, and on the day I was surprisingly relaxed, probably more relaxed than him – as he’s a good friend and colleague, he was understandably keen for everything to go very smoothly.

Obviously, having had a general anaesthetic, I had no recall of the procedure, and came to, quite groggily, in what seemed like an instant. I had clear eye shields on, and apart from some significant peripheral blur, I could see very well, even through the shields. So well, in fact, that I took out my phone and sent a text!

Teleon’s Acunex Vario is made from a
hydrophobic material, with a c-loop
haptic design.

When I got home an hour or so after the procedure, I removed the shields to instill my first set of drops, and had incredibly good central vision, both far and near, certainly very functional. The peripheral blur lasted a few days, as my pupils were strongly dilated, but at my 24-hour post-operative check I read the 6/5 line on the distance chart, and N5 up close. I drove later that day, and have been fully functional without any need for further spectacle enhancement since.

The surgery was not without some of the very common post-operative effects – flare and glare around lights at night, the triggering of dry eye symptoms, and mild cystoid macular oedema, which developed in my left eye about ten days post-surgery. This resolved completely a week or so later with intensive steroid eye drop application. The dry eye symptoms are still present, but resolving slowly, and the flare around lights at night is still quite prominent, but not to the point of making it unpleasant or unsafe to drive. I suspect this particular symptom is not quite as significant as with traditional multifocal implants, but it is more pronounced than I anticipated. I expect it to improve in time.

Teleon’s Femtis IOL is made from a
hydrophilic material, with a capsularfixated
haptic design.

SPECTACLE FREE

In terms of how the EDOF IOL has changed my visual requirements, and allowed me to be independent from spectacles, I could not be happier. As with most hyperopic presbyopes, I could not perform any kind of close work without spectacles. Computing was impossible, and simple tasks at near, that did not necessarily require reading, were very difficult prior to surgery, so I had a total dependency on glasses or contact lenses to be functional in modern life. Even if I got in a lift without glasses, I was not able to see the floor numbers on the push buttons.

I have not required any help post-surgery, and even very fine print, in good light, is easy to read. I feel like I have the vision I had at age 30, and this has made a hugely positive difference. Being actively involved with singing and music, it has made performances so much easier than when I previously had to rely on my monovision contact lens correction. In addition, I’m now better off than diners of a particular age, who arrive at a restaurant hoping they haven’t left their glasses behind!

RECOMMENDING TO PATIENTS

Promoting IOLs to patients is very easy, especially to patients who have seen me on multiple occasions. I told a number of them I was considering surgery, and most of them said “Well, you get it done first, and then I’ll do it”.

While they trust my recommendations, I am very upfront about the potential for post-operative complications, such as the dry eye symptoms, glare, and conditions like cystoid macular oedema, as these are common and need good management.

Darrell Baker

When you are thrilled by an outcome, it’s easy to imbibe a positive context to any recommendation, and I am particularly thrilled (and positive) when recommending EDOF technology. The visual outcome, if you are sensitive to its subtleties, is amazingly natural. With EDOF lens technology, there is a smooth and seamless progression in the focus at any distance. There is no requirement to adopt a particular head or eye posture to see anywhere, and although difficult to appreciate or assess, I am amazed at how objects at different distances are simultaneously in clear focus. It’s remarkable.

Recommending surgery to patients in an optometric practice is easy, and in my mind, it’s a professional obligation to talk about all options for vision correction. You would be doing your patients a disservice if you did not mention refractive surgery as a potential path to clear vision and perhaps full spectacle independence. Whether they choose surgery or not, these patients will make an informed choice, and require ocular health checks for the remainder of their lives.

In our practices, where we are aiming to develop our fee for service model that does not rely on the sale of product, this philosophy works well.

Darrell Baker was the President of Optometry Australia from 2018 to 2021 and is a director of Bullseye Clinic in Western Australia.