AUSCRS Surgeons Sing Praise for 1stQ AddOn Sulcus LensesSurgiVision has hosted its first face-toface conference as a company, with Dr Brian Harrisberg, Dr Alison Chiu, Dr Cameron McLintock, and Dr Andrew Apel discussing their experiences implanting Medicontur’s 1stQ AddOn Secondary Supplementary Sulcus lenses at the recent Australasian Refractive Cataract Surgeon’s Conference in Noosa, Queensland. The 1stAddOn intraocular lens (IOL) is implanted into the ciliary sulcus in addition to the primary IOL in the capsular bag. It can be used for correction of spherical refractive errors, presbyopia and astigmatism, and can be implanted in a single planned procedure, together with the primary in the bag lens, or as a secondary lens at any time later in the pseudophakic eye. According to Dr Alison Chiu, this platform provides reversibility for patients who are not sure about multifocality – it is far less stress inducing to explant a multifocal IOL from the sulcus than to explant from the bag – particularly when you take into account time for neuroadaptation, by which time the bag has usually fibrosed. “Some patients simply can’t decide if they want a multifocal lens – they can’t imagine how the halo and glare will work out, even when we show them it can be hard to understand, and we cannot simulate it,” she said. Dr Chiu stated that the 1stQ AddOn lenses are also ideal as a secondary delayed procedure for patients when the refractive target is not reached, and laser correction is not desirable; for those who had monofocal in the bag IOLs prior to toric IOLs becoming available; for patients with monovision who don't tolerate it, patients who want monovision but were not assessed for it, patients with monofocal IOLs that were not offered or considered for multifocal correction; for patients with irregular corneas; or who have experienced a refractive surprise. Dr Chiu mentioned that “the 1stQ AddOn lenses are rotationally very stable in the sulcus”. DESIGN FEATURESDr Harrisberg described the 1stQ AddOn IOL as a “very large” hydrophilic acrylic lens. Larger than most, it has a 6mm optic diameter and an overall diameter of 13mm. With a “family” of lenses to choose from – the Scharioth Macula Lens (SML) for patients with macular disease, toric, and multifocal – surgeons can add the component they need to make it work for the patient. Discussing the design, Dr Harrisberg said, “The notch is key because this lens is not equiconic, it is convex-concave. There is no vaulting, but it is very well structured and is stable in the sulcus. “The key is rotational stability; 1stQ AddOn lenses have four-points of fixation and very little ciliary sulcus interaction. I believe the lens is safe and unlikely to cause issues with uveitis.” Dr Harrisberg has had macular disease patients fitted with the SML lens describe the procedure as “life changing”, enabling them to work, drive and function without glasses. “The SML is literally ‘do no harm’ because the central rain drop +10.0D is so small that the patient’s distance vision is not affected. “So, it’s a system of lenses that really enables us to manipulate how people use their vision,” he said. Dr Apel said the “+10.0D AddOn lenses have been marvellous; patients have been ecstatically happy… The indications for the use of this lens are currently tight but may change over time. The lens gives patients extra reading ability which they have not had before.” “ This gave the patient reversibility for the multifocal portion, while curing her refractive error and induced presbyopia Additionally, he commented on the “great variety of applications” for the 1stQ AddOn lenses. Dr Apel has used 1stQ AddOn lenses “as top-ups for refractive error post-operatively, in patients with a multifocal lens in one eye and a monofocal lens in the other eye, and in patients with corneal transplantations”. Caution is advised with implanting secondary supplementary sulcus lenses in patients with hydrophilic in the bag IOLs to mitigate the small, but clinically significant, risk of secondary calcification of the primary in the bag IOL. When selecting IOLs, Dr Chiu stressed the importance of considering each patient’s needs, lifestyle and specific visual tasks. This includes exploring their acceptance to wear glasses, and for what tasks, if any. Also consider stereopsis if thinking of implanting a monovision IOL, their ability to tolerate halos and glare if considering multifocals, the patient’s personality type (not to be underestimated), and concomitant conditions such as dry eye and macular degeneration. “When laser refractive correction is not an option, IOL implantation is the way to go, and if there is enough anterior chamber depth, we can use a 1stQ AddOn lens to provide reversibility or a delayed procedure when required,” Dr Chiu said. Dr Chiu presented a case study in which she fitted four lenses in two eyes of one patient in one day. The patient wasn’t suitable for laser; and her anterior chamber depth was insufficient for an ICL. Angle alphas were high and flagging red, and the Chang-Waring chord was also on the high side. The only option was a refractive lens exchange but there were concerns about implanting a multifocal IOL into this patient. “I tend to do bilateral surgery with multifocal IOLs for better binocular summation,” she explained. Dr Chiu chose to implant a monofocal toric IOL into the capsular bag, correcting the patient for emetropia and, with adequate depth in the anterior chamber, a plano power Trifocal 1stQ AddOn lens into the ciliary sulcus. “This gave the patient reversibility for the multifocal portion, while curing her refractive error and induced presbyopia,” she explained. Dr McLintock highlighted the value and ease of explanting a 1stQ AddOn sulcus lens in a patient who changed their mind about eliminating prior monovision correction from previous cataract surgery. He cited a paper he published with Dr Apel and Dr James McKelvie on toric monofocal 1stQ AddOn lenses for patients with astigmatic refractive error following cataract surgery. In a study of 22 eyes, with a minimum of three months follow-up, they found that 82% of eyes achieved 6/6 vision or better; and 100% of eyes achieved 6/7.5 vision or better. All patients were within half a dioptre of the target spherical equivalent; 82% of eyes had less than half a dioptre of residual cylinder. Two patients needed IOL rotation, however Dr McLintock believes this was higher than in clinical practice. “Rotational stability of the lenses is excellent,” he concluded. View the symposium at watch?v=wps09h8VIVc.

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