Ophthalmologists choose lenses for their own procedures

The newer IOLs have taken hold of surgeons’ expectations.

Issue: September 1, 1999

WARNER ROBINS, Ga. — Ophthalmologists facing cataract surgery enter into the prospect knowing about every aspect of the procedure they face. Yet surgeons who have performed phaco on other physicians or have had it done themselves say they learned even more about the latest in IOL technology.

Johnny Gayton, MD, developed epidemic keratoconjunctivitis 2 years ago and became steroid dependent. He developed a posterior subcapsular cataract.

“When an ophthalmologist has to have cataract surgery, you have to start thinking about a lot of things — how do you want your refraction to be, what type of surgery and which type of implant do you want?” he said.

He chose monovision, with his dominant eye adjusted to near because of an existing radial keratotomy. This would allow him to read without glasses in multiple illumination settings. He wanted a temporal approach, which he has used since 1985 and was convinced was better.

He wanted an AcrySof lens (Alcon; Fort Worth, Texas) because of the decreased incidence of posterior capsular opacification (PCO), thus reducing the chance of needing a YAG laser treatment.

PMMA lenses would require a larger incision and would increase recovery time, he said.

He chose to avoid a retrobulbar block because of slower recovery time and increased risk with the needle. He did not want a silicone lens because of the slightly higher likelihood of inflammation and PCO.

“Having been a myope, I knew I was at a slightly higher risk for a retinal detachment, especially at a young age,” he said.

From these criteria, he chose Richard Mackool, MD, who used those surgical techniques.

“I was quite happy with my choice and with my results,” he said. “I’ve got a totally normal visual field. I’ve done a fair number of physicians myself. I’ve almost exclusively put an AcrySof lens in them.”

Potential realized

Hans-Reinhard Koch, MD, of Bonn, Germany, operated on an ophthalmologist who had referred patients to him for 20 years and told him that she would be his next patient. But she requested a multifocal lens, which Dr. Koch had not yet used.

Multifocals come with a tradeoff, he said. They reduce spectacle dependency for normal vision but can create glare and halos.

“Up to that time, I was a bit reluctant to put multifocals into people who obviously need the best visual acuity and contrast,” Dr. Koch said. “I tried to dissuade her. The lens is nice for the ordinary person who does not expect much from vision but wants to go for compromise and reduce spectacle dependency as much as possible.”

For the next year, the physician still continued to refer patients and re quested multifocals in each one. After following the results, she chose the multifocals.

“Considering all these little details that the ophthalmologist has to see, I still was thinking, ‘Would she still want a multifocal?’” Dr. Koch asked.

Postoperatively, the physician was emmetropic, and Dr. Koch performed her second eye 2 days later. Preoperative acuity was 0.8 D (20/25 Snellen) and postoperatively, she achieved 1.2 D (20/16) at distance. Near uncorrected visual acuity was 0.7 D (20/30) and 1 D (20/20) with spectacles.

“She still sends me her patients and still writes in most of her cases as multifocal lenses,” Dr. Koch said. “It really trained us about the potential for multifocal lenses.”

Positive impact

“I use almost exclusively foldables,” Dr. Koch said. “The only indication for a nonfoldable is when a lens power is not available, such as –6 D correction or +36 D.”

In Germany, he also can order higher power PMMA lenses for extreme cases. Dr. Gayton said he would switch to other makes of IOLs for piggyback cases, although he has not needed to do this with any ophthalmologists.

Dr. Gayton added that he also would vary his usual choice to the MemoryLens (CIBA Vision; Duluth, Ga.) for patients who might need a penetrating keratoplasty later. This lens allows him to clean up the viscoelastic more thoroughly and is firmer inside the eye.

Receiving an IOL did not affect his practice at all, and has no impact on his view through the microscope.

Physicians may be the worst patients, but physician patients can make for better physicians.

“It made it easier to talk to patients,” Dr. Gayton said. “They liked knowing that I had gone through it. It seemed to make them a lot more comfortable. It also made me more sympathetic.”

For Your Information:

Hans-Reinhard Koch, MD, practices at the Klinik Dardenne 2XLD, Friedrich-Ebert-Strasse 23-25, Bonn D-53177 Germany; (49) 228-830-3132; e-mail: h.koch@ndh.com. Dr. Koch did not participate in the preparation of this article.

Johnny Gayton, MD, practices at 216 Corder Road, P.O. Box 6479, Warner Robins, GA 31088-3604; (912) 923-5872; fax: (912) 929-6266. Dr. Gayton has no direct financial interest in any of the products mentioned in this article. He is a member of the Alcon Speakers Bureau.