Multifocal and EDOF IOLs: My Rationale for Use in Patients With Glaucoma

These technologies can be safe and perform well in glaucomatous eyes.

John P. Berdahl, MD

Glaucoma Today

Key Takeaways Conventional thinking has suggested that only pristine eyes qualify for the use of multifocal and extended-depth-of-focus (EDOF) IOLs in cataract surgery. Ophthalmologists, however, must think beyond the limited data sets and combine a solid understanding of the existing evidence with logic, with experience, and with what they would want for their own eyes. When stacking the minimal contrast sensitivity loss that occurs with multifocal and EDOF IOLs on the modest contrast sensitivity loss seen in early glaucoma, patients can be happy and achieve their visual goals with these lenses. Conventional thinking has suggested that only pristine eyes qualify for the use of multifocal and extended depth of focus (EDOF) IOLs in cataract surgery. This belief is partially evidence-based due to a paucity of randomized controlled clinical trial data—the highest-quality evidence does not exist to support their implantation in eyes with corneal aberrations. That said, ample research has demonstrated that multifocal and EDOF IOLs are safe and can perform well in patients with mild and probably moderate primary open-angle glaucoma (POAG).1-5 My own experience has shown this to be true. To challenge conventional thinking, ophthalmologists must think beyond the limited data sets and combine a solid understanding of the existing evidence with logic, with experience, and with what they would want for their own eyes. It is also important to consider the exit strategy: Is this an IOL that can be easily exchanged if necessary? Given the minimal contrast sensitivity loss that occurs with multifocal IOLs and EDOF IOLs and the modest contrast sensitivity loss seen in early glaucoma, patients can be happy and achieve their visual goals with these lenses. This article details considerations for their use in patients with POAG.

Potential Treatments for Postmenopausal Dry Eye

Current therapies may merely treat signs and symptoms, not the underlying issue.

Bonnie-Kim Schwertz, OD, FAAO

Modern Optometry

How to Identify and Stop Revenue Leaks

Take a close look at your current processes to find ways to improve profitability.

Jessica Schroeder, MPH, CPC, OCS, OCSR

Retina Today

KEY TAKEAWAYS There will always be a push to find new revenue streams, but it may behoove you to also ensure that your current revenue streams are performing their best. To confirm that your internal processes are functioning as intended, it is important to review written procedures and determine whether they are being followed. Coding errors stemming from outdated references, missed modifiers, or misapplied guidelines could cause denials or audit failures. As the year winds down, many retina specialists are anticipating another round of reimbursement cuts from payers. Practices face the continual challenge of having to do more with less while trying to remain profitable. There will always be a push to find new revenue streams, but it may behoove you to also ensure that your current revenue streams are performing their best. Taking a close look for both human and process errors could improve your bottom line. Start with a broad look at your revenue cycle process. Remember, everyone in the practice is involved, not just your billing and coding staff. From patient intake to back-end claims, there are many areas to investigate for process improvement opportunities (Figure).