Moving forward one feature at a time

Issue: September/October 2010

Since its inaugural issue back in April, Premier Surgeon has already come a long way in terms of introducing new features. Shiny new website? Check. New column focused on designing productive, efficient practices? Got it.

Continuing that innovative tradition, in this issue PS presents two of its newest additions, both of which are meant to get premium IOL surgeons like you more involved in the dialogue.

Consultation Corner

As previewed in the July/August issue, Y. Ralph Chu, MD, will present a series of unique cases he’s addressed in his practice at Chu Vision Institute. Readers are highly encouraged to respond and give insight into how they would have approached each case. Furthermore, we encourage you to submit your own unique cases and the methods with which you addressed them. After all, what better way to learn and expand your practice than to see what others are doing, too?

To see the first of these cases and how members of our PS250 responded, see “Is a premium IOL the right choice?” in this issue’s installment of Consultation Corner.

The ‘A-ha! Moment’

You have had this moment. The moment you knew premium IOLs should be a large part of your practice. The moment you realized that one special pearl will make all the difference in your patient outcomes. The moment you uttered the right turn of phrase to help a patient understand the difference between a monofocal and premium IOL. The moment you hired the right person for refractive coordinator. The moment when trepidation was replaced with confidence.

We’d like you to share those moments with your colleagues. It could make all the difference in patient outcomes and will be a lot of fun to share words of wisdom.

Send your 150-word “My A-ha! Moment” to me at chvisdas@slackinc.com to share. If selected, your moment will be posted on PremierSurgeon.com and the PS Facebook page. It will also be entered to win “Curbside Consultation in Cornea and External Disease: 49 Clinical Questions” by Francis W. Price Jr., MD.

To give you an idea of what others have already had to say, take a look below. Perhaps you, too, have shared this same moment, once upon a time.

— Cara Hvisdas
chvisdas@slackinc.com

What’s your ‘A-ha! Moment’?

I first realized that presbyopia-correcting IOLs (PIOLs) would change the future of ophthalmology on May 5, 2005. I received a morning phone call while on vacation from a representative of eyeonics, then the maker of the Crystalens implant, informing me that the Centers for Medicare and Medicaid Services had issued a ruling allowing Medicare beneficiaries to receive premium implants. Until that time, PIOLs could only be offered to the non-Medicare population. Though Crystalens, ReSTOR and ReZoom had been approved almost 2 years previously, they couldn’t be offered to most cataract patients! The CMS ruling opened the way for most cataract patients to have access to the best IOL technologies. It signaled to innovators and industry that a market for PIOLs had been created overnight. Most importantly, the ruling re-defined cataract surgery from a procedure to correct disease to an opportunity to restore youthful vision to an aging population with an ever-increasing desire to live younger and better. — John A. Hovanesian, MD, FACS

My epiphany began quite awhile ago when my colleague, Dr. Guy Kezirian, and I were talking about outcomes. Now at this point in the early 90’s, we were discussing refractive outcomes. However, later when we were discussing the same topic with Dr. Jack Holladay, we found out that he was bringing cataract outcomes into the mix. This concept was not new to me, having worked with Dr. Steve Brint and Dr. Bruce Wallace, but even so we still had the line, “Here’s your glasses; your surgery went perfectly.”

During the next several years, Drs. Kezirian and Holladay collaborated on several different data collection pathways for refractive surgery and what we now commonly call refractive cataract surgery. I had the opportunity to provide data for that early software. We learned a lot over the years, but still 20/40 or better was what our slides showed at all of the major meetings.

Fast-forward to today. I just returned from a meeting where our data presented from one of the latest FDA trials on Topographic Guided LASIK with the Allegretto Eye Q from Alcon showed a majority of the patients seeing between 20/10 and 20/16. Many of the patients in fact gained 1 and even 2 lines of vision over their best-corrected preoperative vision in either their glasses or contact lenses. Now that is an “A-ha Moment!” Finally, we may be able to say 20/10 in 2010 is what we can produce in refractive surgery. However, refractive cataract surgery still has a bit of a hill to climb.

The nice thought surrounding outcomes analysis is that at least we have more and more surgeons doing it. With the collection of data like that found in the outcomes analysis software Datalink, we can actually look at various lenses across the board and determine what works best in which patients. We again have only seen the tip of the iceberg, but at least we now know there is a lot more underneath to be found. — Karl C. Stonecipher, MD

Although I wish there was a single “A-ha moment,” my experience has been that there have been numerous ups and downs with PIOLs. With each new technology – from the original ReSTOR and earlier versions of the Crystalens to the latest PIOLs – I would have some patients who would be ecstatic, and I would think “This is it!” However, unfortunately I would later run across some patients with the same technology who were less than happy. I soon realized that PIOL technology can be an amazing option for some patients, but there are a small percentage of patients who end up less than happy.

One of the most important changes I made to my practice (and perhaps this is the “A-ha moment”) was to perform a preoperative topography and OCT prior to all PIOLs, which helped me identify only appropriate candidates. Furthermore, identifying and treating dry eye and blepharitis prior to my final measurements for IOL selection has also helped me end up closer to my target refractions and has led to improved success.

Overall, I realize that with each improvement in technology, coupled with better preoperative screening, I can provide my patients with a higher chance (but still not a 100% chance) of achieving excellent visual results with PIOLs. — William B. Trattler, MD