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Refractive cataract surgery with premium IOLs will benefit patients and surgeons
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In the early 1980s, after seeing the positive impact that radial and astigmatic keratotomy was having on my younger patients’ quality of life, I became motivated to transfer these skills to my senior patients undergoing cataract surgery. I coined the term “refractive cataract surgery” and began investigating the premise that a cataract surgery patient’s quality of life could also be enhanced by reducing his or her dependence on glasses.
 Richard L. Lindstrom |
It was already clear to all ophthalmologists that placement of an IOL, allowing utilization of a normal pair of spectacles rather than the optically compromised aphakic spectacles, was a great advance and generated superior patient satisfaction and quality of life. But few surgeons were convinced that aggressively treating defocus, astigmatism and presbyopia was important to the more senior patient. After all, these patients were used to wearing glasses.
Beginning with careful biometry to reduce defocus, intraoperative incision management and corneal relaxing incisions to reduce astigmatism, and monovision for presbyopia, it soon became apparent to me that even those in their 80s and older appreciated reduced dependence on glasses.
Focusing on these skills generated significant word-of-mouth patient referral, and my cataract practice prospered. This motivated me in 1985 to work with IOLab on the first refractive multifocal IOLs, 3M Vision Care on the first diffractive multifocal IOLs and later eyeonics on the first accommodating IOLs.
New era of refractive management
After nearly 25 years, secondary to an extraordinary investment of time and money by innovative ophthalmologists and manufacturers, we are entering an era in which management of refractive outcomes after cataract surgery is now a core priority. As we enter 2009, the S-shaped adoption curve for refractive cataract surgery is reaching the middle majority, as more than 70% of cataract surgeons now offer a so-called premium IOL, either multifocal, accommodating or toric, to their patients.
While premium IOLs today account for only approximately 10% of the 3 million implants done per year in the United States and less than 1% of the 15 million lenses implanted annually worldwide, they represent the fastest growing segment in the most common surgical procedure performed globally. This represents an extraordinary opportunity for every cataract surgeon.
However, along with the opportunity comes the responsibility, as always, to put our patients’ best interests first by honestly and transparently disclosing the strengths and weaknesses of each lens implant alternative and guiding each patient individually to the best technology for their personal lifestyle needs. In addition, it is important that we charge our patients appropriately so that they achieve fair value for their money and we individually and as a profession retain their trust.
Advances in excimer laser corneal refractive surgery over the past decade generated a procedure with a very high patient satisfaction rate and more than $2 billion per annum in incremental fees to ophthalmology in the United States alone. I believe refractive cataract surgery with premium IOL implantation, both in regards to enhancement of patient quality of life and economic impact on ophthalmology, will generate a similar impact on our profession in the next decade.
Excellence in cataract surgery is what defines the comprehensive ophthalmologist in America. With the aging population, we can expect to be doing 4 million cataract operations per year in the United States by 2020. Those ophthalmic surgeons who master the skills of refractive cataract surgery and premium IOLs can expect a strong demand for their services and highly appreciative patients.