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Surgeon: Four keys can help improve the success of cataract surgery
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LAS VEGAS — With patient expectations on the rise and cataract surgeons facing increasing pressure to provide near-perfect refractive outcomes, four fundamental keys to successful surgery should be adopted, according to Uday Devgan, MD, FACS.
 Uday Devgan |
Dr. Devgan, an OSN Cataract Surgery Section Member, discussed those keys here at the OSN Las Vegas meeting. "The sun is setting on old mindsets about doing cataract surgery," he said.
To meet the needs of younger, more affluent patients with better preop best corrected visual acuity who expect better postop distance results, surgeons must first look to increase refractive accuracy, Dr. Devgan said.
"Patients won't be happy if you don't achieve the desired refractive results. Hone your lens [calculations]," he said.
Surgeon should choose an IOL calculation formula and be sure to determine the true K power, particularly in post-LASIK eyes. They should also be sure to "fix postop surprises," Dr. Devgan noted.
Postop remedies might entail an IOL exchange, a piggyback IOL, LASIK, PRK or another refractive procedure.
"If you are not comfortable doing this, it is easy to pair up with a refractive surgeon in your community," he said.
The second key to successful surgery is addressing astigmatism. Surgeons should take topographic measurements and note the effect of the incisions on corneal flattening. Using paired incisions can reduce astigmatism by about 1 D, Dr. Devgan said.
Limbal relaxing incisions are another technique surgeons should learn to manage postop astigmatism, he added.
The third key to surgical success is to minimize complications and deliver clear corneas. Dr. Devgan advised using a phaco chop technique to minimize ultrasound energy, avoiding complications such as broken lens capsules and switching to silicone-coated phaco tips. He also advised employing an NSAID in every case to reduce the risk of cystoid macular edema.
The final key: "Exceed patient expectations," Dr. Devgan said.
He advised determining what the patient wants by using a questionnaire or Dell survey and setting realistic postop expectations from the beginning.
"If you want to try new technologies or a new technique, choose your patients very carefully," he said. The "right" initial patient is a hyperope with low astigmatism and an "easygoing personality," he said.
These patients are generally not looking for perfect vision and are willing to take the time to adapt to their new vision, he said.