Dr. Thomas Kohnen kicked off the AUSCRS conference programme during mid-October, delivering the Gold Medal Lecture. Thomas has an impressive resume with wide ranging experience in ophthalmological clinical practice and science. Based in Frankfurt at Goethe University, he leads a team that helps 35,000 patients annually.

Thomas detailed surgical correction of cataract and said multifocal intraocular lenses (IOLs) are now the majority of the IOLs he uses, with very high levels of patient satisfaction.

Trifocal IOLs are his first choice. He reported on a specific trifocal IOL, stating that 98 per cent of recipients would choose the same IOL design again, with low levels of complaints about glare and haloes etc. Diffractive optics are his go to choice and are now available for high myopes.

An interesting development we can expect are add-on (piggyback) trifocals that can be implanted over existing monofocal IOLs. These could be a game changer for patients with older IOLs seeking greater spectacle independence.

Thomas said segmental refractive trifocals are also making an impact, as are extended depth of focus (EdoF) designs. Small aperture IOLs can be successful in complex cases like cataract patients with existing radial keratotomy and keratoconus. He said accommodative IOLs have so far not achieved much success.

Thomas summed up with eight clinical pearls, covering indications and contraindications for IOLs:

  1. Avoid trifocal IOLs in patients with dry eyes, irregular corneas and pathology, glaucoma, retinal disease, e.g. age-related macular degeneration (AMD), but use them for patients who seek spectacle independence, with high visual demands (except pilots and drivers), lways respect macular pathology,

  2. EdoF can be considered for irregular astigmatism and patients who seek decent intermediate vision,

  3. Centration is critical, as is accurate capsulorhexis – femtosecond assisted cataract surgery may have benefits in this regard,

  4. Optics is important and glistening

  5. free materials are desirable. He also

  6. noted that significant patient satisfaction improvements occur after the implantation of the second multifocal IOL,

  7. Use the best calculators to improve targeted refractive end points,

  8. Toric IOLs should be considered wherever possible/necessary for enhanced outcomes and satisfaction, along with digital or manual axis marking.

  9. Finally, Thomas stated that one can consider touch up excimer laser refractive surgery or add-on IOLs to tweak outcomes and satisfaction.

Article reproduced from 14 December 2018 edition of mivision.