Refractive lens exchange is the wave of the future

Patients are willing to pay to have a premium surgical experience and to ‘see young again,’ cataract surgeon says.

ByUday Devgan, MD

Introduction

Cataract surgery with a refractive component is certainly where the future is headed. Uday Devgan, MD, FACS, a very accomplished cataract and refractive surgeon, with worldwide notoriety, has eloquently summarized refractive lens exchange, regarding where it is today and how we as ophthalmologists need to prepare for the future.

With the evolution of better phaco technology and techniques, increasingly more adaptive IOLs to aid in presbyopia correction and adjuvant treatments such as limbal relaxing incisions and excimer laser refinements to help with postop “perfection,” we will definitely see surgery evolve over the next little while. It is certainly an exciting time in ophthalmology, and I urge you to read on to find Dr. Devgan’s insight into the future of refractive cataract surgery.

Rosa Braga-Mele, MD, FRCSC
OSN Cataract Surgery Section Editor

Uday Devgan

I think it is important for surgeons to offer the full spectrum of refractive surgery in their practice, not just one little procedure. While our practice covers the entire range of refractive procedures, from LASIK to phakic IOLs, the future for our practice is elective refractive lens exchange.

Cataract surgery is already the most common surgical procedure performed in the United States. But with the anticipated aging of the population, the Medicare system will not be able to provide for the large volume of patients anticipated in the future. This will lead to further declines in reimbursement, with surgeons struggling to stay above water.

As refractive lens exchange (RLE) surgical volume increases, we will see a lessened load on the Medicare system because the patients will reach retirement age already being pseudophakic. In our practice, the volume of RLE has increased steadily, and we project even more growth in the years to come.

Accurate correction of refractive errors, particularly presbyopia, is the driving force. If we have a 55-year-old patient with 4 D of hyperopia, needless to say, he is not going to get LASIK because RLE would provide better results and would eliminate the future need for cataract surgery. The same applies for patients with lesser degrees of refractive errors but with early onset of nuclear sclerosis. If we have a 68-year-old Medicare patient who has a very mild 20/25 cataract and 2 D of hyperopia, RLE would also be the procedure of choice. Because the cataract is not truly visually significant, the patient would pay for an RLE to enjoy additional years of quality vision instead of waiting for more vision loss and failing the state driving test, for example.

The train of progress never stops, and new technology is clearly coming. Every generation of lens is going to get better and better. It is just a question of time before we have a truly great accommodating lens capable of restoring large amounts of accommodating amplitude. And once that happens, we will have a relative “cure” for presbyopia, and the floodgates will open.

To enhance accuracy, some patients are going to need excimer-based enhancements, of course, and some are going to need a biopic procedure, so that needs to be part of the equation as well. The light-adjustable lens technology would also be an asset here to help fine-tune refractive results after RLE.

A different kind of patient population

But the saving grace for everything is going to be the baby boomers. We have heard the warning that there is going to be a huge number of baby boomer patients and increasingly fewer ophthalmologists to care for them. That spells a lot of work and a lot of opportunities for you and me.

These patients are very smart, intelligent, well-read and well- informed. They know your Web site inside and out. I have had patients fly from other states because they saw an article I wrote. These patients are exceedingly well-read, and that is a good thing. The more informed the patients are, the more realistic their expectations will be.

Today’s baby boomer patients are well-to-do and have a thirst for luxury, and they want to enjoy their active lifestyle.

It is not about the cost for these patients; rather, it is about the fear they have. They really want to be young again, and being young to them means seeing young again – and that means no more reading glasses. They are extremely motivated to do this.

If you tell them, “I can restore your vision so you’ll be able to read a newspaper,” they are surprised. They are amazed. And you can deliver this level of happiness to them.

Creating a luxury experience

As Shareef Mahdavi of SM2 Consulting says, a major factor is the “experience” for the patient. And we are really learning a lot about this. The patients want that luxury experience, and they want value.

We are trying to deliver an experience where our results exceed the patient’s expectations. A lot of people are involved here, from technicians to doctors to all of the staff. It is about the teamwork, where everyone has the goal of delivering the highest quality.

In the next few years, RLE will continue to grow at a rapid rate. More and more patients will realize that it is advantageous to have RLE surgery before the development of visually disturbing cataracts. Our most precious commodity in life is time, and why suffer through years of diminished vision when you can have clear vision now?

For more information:

Uday Devgan, MD, FACS, is in private practice in Los Angeles, chief of ophthalmology at Olive View-UCLA Medical Center and an assistant clinical professor at the Jules Stein Eye Institute at the University of California, Los Angeles. He can be reached at 10921 Wilshire Blvd., #900, Los Angeles, CA 90024; 310-208-3937; fax: 310-208-0169; e-mail: devgan@ucla.edu; Web site: www.maloneyvision.com.