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    Lessons learned in adapting EDOF IOLs


    Figure 3. A patient’s hand-drawn representation of how he perceives points of light from each eye when the dominant right eye was implanted with an EDOF lens and the non-dominant left eye with a low-add multifocal.

    3. Consider mix-and-match for myopes

    Myopes may become accustomed to removing their glasses to see at near. I address this by implanting an EDOF lens in the dominant eye first; then engage the patient in the decision about whether it provides the desired near vision. If the patient would like a better near vision, I implant a low-add multifocal (typically a Tecnis Lens ZLB00 [Johnson & Johnson Vision] with a +3.25 D add). This was beneficial for a recent patient who is a physician in internal medicine. He loves the blended vision because it gives him great distance and intermediate vision, but still allows him to read EKG printouts (See Figure 3).

    4. Push plus in postop refractions

    Refracting a patient with an EDOF lens requires a unique approach, so it is important to work closely with technicians and co-managing optometrists to make sure the patient knows what to expect. This tuturial video can be a useful training tool.

    EDOF lenses love to “gobble up minus” so surgeons should start at plano and ask the patient, “Better 1 or 2?” The patient may ask for more minus.

    For a more accurate refraction, fog the patient first. Start with +1.50 D in the phoropter, then take away plus in 0.25-D steps until the patient can just read the 20/20 line.

    This is the “real” refraction. My early results reflect a lower-than-actual 20/20 rate because my staff did not know to do this in early cases.

    With these changes, patients are achieving excellent results with EDOF lenses.


    Cynthia Matossian, MD

    E: [email protected]

    Dr. Matossian is founder and CEO of Matossian Eye Associates in Pennsylvania and New Jersey. She also serves as a clinical instructor in the Department of Ophthalmology, Temple University School of Medicine, Philadelphia. Dr. Matossian is a consultant for Johnson & Johnson Vision, Alcon Laboratories, and Bausch + Lomb, as well as other companies not relevant to this article.

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