Emmetropia should be target of refractive cataract surgery, surgeon says

NEW YORK — The goal of refractive cataract surgery is postoperative emmetropia, and surgeons should always keep that in mind, a speaker here said.

"That means a spherical equivalent of plano to –0.25 D, postoperative astigmatism being reduced to less than or equal to 0.5 D, and not changing the original axis of astigmatism," said William J. Fishkind, MD, FACS. He discussed important considerations for accurately performing refractive cataract surgery at the OSN New York Symposium.

Dr. Fishkind said the technique for refractive cataract surgery should include a small, temporal clear corneal incision, limbal relaxing incisions (LRIs) to correct astigmatism, a centered continuous curvilinear capsulorrhexis, and cortical cleaving hydrodissection.

Accurate preoperative biometry is also vital, he said.

"You want to target emmetropia, which means perform a neutral incision astigmatically, incorporate LRI's into your surgical plan, decrease postoperative astigmatism to less than 0.5 D, hit the spherical correction to –0.25 D or plano," Dr. Fishkind said. "Perform flawless surgery, implant an IOL that will maximize visual outcome and minimize [posterior capsule opacification], and customize the implant to meet patient needs."

Surgeons who choose to use presbyopia-correcting IOLs must also adjust to patient-share billing for the surgery with premium lens pricing, and they must be prepared to perform enhancements for what would previously have been considered minor refractive errors, he said.

Additionally, staff members must be trained to counsel patients about presbyopic lenses as well as in scheduling and in financing surgery for those who may need it, Dr. Fishkind said. Documentation is also critical, he noted.