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Now is the time to adopt refractive cataract surgery skills
 Richard L. Lindstrom |
More than 30 years ago, I returned to my hometown in Minnesota to assume a faculty position at the University of Minnesota after completing 2 years of fellowship training that included in-depth experience in phacoemulsification and posterior chamber lens implantation.
At this time, less than 1% of U.S. surgeons had adopted phaco and posterior chamber lens implantation as their preferred technique for managing the routine cataract. I immediately incorporated these procedures into the training program for our residents and fellows, and began teaching courses on a frequent basis to help all interested regional surgeons adopt these new skills.
Many surgeons who were in their senior years with well-established surgical practices asked me in confidence whether it was really necessary for them to learn phacoemulsification and posterior chamber lens implantation, a significant challenge for those with a career-long experience in intracapsular cataract extraction and a comfort zone with anterior chamber lens implantation, which was dominant at that time. I remember sincerely counseling these committed surgeons that if they intended to retire or stop doing surgery in 5 years or less, I thought they could comfortably complete their careers without learning phacoemulsification and posterior chamber lens implantation, but if they intended to practice cataract surgery longer than that, it was absolutely mandatory for them and in the best interest of their patients to incorporate these skills into their practices.
Some chose to retire from surgery, but most accepted the challenge and moved into the modern era of cataract surgery and lens implantation that dominates our practices in the advanced world today.
I believe we are at the same point today in regards to refractive cataract surgery skills. Any cataract surgeon expecting to maintain a practice in 5 years must learn the skills required to properly manage presbyopia and astigmatism in their practices. These skills in my opinion include the ability to confidently counsel and offer monovision, toric IOLs, multifocal or accommodating IOLs (preferably both), as well as the ability to enhance postoperative refractive outcomes when needed.
Those of us who have practiced for decades know how difficult it is to incorporate new surgical skills into our practices in the midst of all the demands of a busy ophthalmology practice and life in general. Rightly so, we are careful which new procedures, devices and drugs we offer those patients who have trusted us to preserve, restore and enhance their vision. Still, in my opinion, it is now time to accept as fact that the ability to treat presbyopia and astigmatism and reduce dependence on glasses in the cataract patient is now a required skill for the surgeon who plans to continue in the field 5 years hence.
We all must stand ready to assist our colleagues in adopting the skills required so that the maximum number of patients are benefited with the smallest possible morbidity. We did it before as we transitioned a generation of surgeons from intracapsular cataract extraction and anterior chamber lens implantation into phacoemulsification and posterior chamber lens implantation. It is time to do it again.