공지사항
2009-03-31
SEE삼성안과
최근 백내장수술후 프리미엄 인공수정체(비구면, 다초점 인공수정체)삽입에 대한 요구가 늘면서
비싼 가격만큼 수술 후 만족도를 늘릴 수 있는 방법에 대한 연구가 활발히 진행되고 있다.
최근 남녀에 따른 성의 차이를 고려하여 다초점 인공수정체의 종류나 돗수를 결정해야 한다는 흥미있는 보고가 있었다.
Dr Magda Rau에 따르면 남자가 여자보다 더 중거리-원거리 시력을 중요시하게 생각했고, 야간 빛번짐이나 달무리에 더 민감했다.
여자에서 +0.25~+0.50D 정도 돗수를 더 했을때 만족했고, 평균 근거리 독서거리도 5cm정도 더 짧았다.(43 vs 38cm)
이를 역사적 행동과학 측면에서 보면 남자는 야생동물을 사냥을 위해 원거리 시력이 더 필요했고, 여자는 딸기나 바느질, 요리를 위해서 근거리 시력이 더 필요했다는 생각과, 여자가 남자보다 평균 더 체격이 작고 팔도 짧으므로 근거리 독서거리도 더 짧을 거라는 생각이다.
어쨌든간에 다초점 인공수정체의 삽입에 있어서 남자가 근거리를 잘 보이게 하는 Diffractive IOL후 불만족률이 높고,
야간빛번짐이나 달무리에도 더 민감하므로 상담에 훨씬 더 주의를 기울여야 하고, 남자에서 다초점 인공수정체를 삽입할때는
Diffractive IOL(예,Technis)보다는 중-장거리가 더 잘보이는 Refrative IOL(예, ReZoom)이 더 좋으리라 생각된다. (여자는 Diffractive Technis IOL)
Do gender differences affect patient satisfaction after
implantation of multifocal IOLs?
By Magda Rau, MD
Some behavioral scientists speculate that certain gender-based behavioral patterns are largely unchanged since the Ice Age. As hunters men were required to search for wild animals, which required clear distance vision. As the gatherers women spent their time collecting berries, sewing and cooking meals – tasks that require good near vision.
After prescribing reading glasses for thousands of patients, I have observed that men and women continue to demonstrate different requirements. On average women tend to request prescriptions that are between +0.25 and +0.50 higher than men of the same age group.
We compared the optimum distance for reading books or magazines favored by women aged 28 to 50, with the distance preferred by men of the same age group. We examined the optimal desired reading distance of 100 men (average age 38 years) and 100 women (average age 36 years).
For men, the result was 43 cm (17 inches), and for women it was 38 cm (15 inches), a statistically significant difference. What accounts for the 5 cm (2 inch) difference? Younger women have a tendency to hold reading materials closer to their face, and as a rule women are generally smaller than men, with shorter arms.
Our theory that gender affects multifocal IOL (MFIOL) satisfaction is not strictly based upon assumptions about prehistoric populations, but on valid data. From 1999 to 2007, we evaluated and compared the satisfaction rates of men and women after implantation of various multifocal IOLs.
Our Approach
We always use a two-phase approach (staged implantation), with implantation in the second eye performed four to eight weeks after implantation in the first eye.
When male patients request a clear lens exchange, I initially implant the refractive MF IOL ReZoom into the dominant eye, followed by an exam four to eight weeks later, and an in-depth discussion about options.
If the patient is satisfied with the MFIOL, I continue with the same type of lens. The calculation is optimized based on available data. If the patient is only interested in a slight improvement in near vision, I calculate the refractive MFIOL slightly in the minus range of -0.5.
For clear lens exchange in female patients, I begin with the non-dominant eye and implant a diffractive Tecnis IOL, or refractive lens with a central zone for near vision (ReZoom). If the patient is still satisfied four to eight weeks later, I continue with the same IOL or if the patient prefers better visual acuity in the medium to far range, I combine this with a refractive ReZoom lens.
Women and men obviously have different requirements regarding multifocal lenses. Is this surprising? With smaller size and stature, women tend to hold reading materials closer to the eye and sit closer to computers. Women often attach greater importance to near vision and wish to be independent of reading glasses. Men, on the other hand, are more demanding about clear distance vision, and appear to be more troubled by glare and halos.
In my experience, dissatisfaction after Refractive ReZoom IOL implantation is highest among male patients, therefore I suggest that male patients be counseled more carefully, the desired reading distance should be discussed, and potential glare and halos must be explained in great detail.
Taking gender differences into account as a factor for patient acceptance allows you to optimize IOL mixing and matching and results in greater patient satisfaction.