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Surgeons must approach refractive lens exchange with the knowledge to explain risks
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HONG KONG — While refractive lens exchange can provide an array of visual benefits, surgeons must arm themselves with knowledge to convey the potential risks to patients who are candidates for the procedure, a speaker said here.
 Emanuel S. Rosen |
Emanuel S. Rosen, MD, FRCOphth, told attendees of the World Ophthalmology Congress that he feels the benefits of this procedure outweigh the risks, but the risks cannot be underestimated.
"The positive, life-changing benefits are immense for patients who suffer from high ametropia. The relief from high spectacle correction or contact lens intolerance is really great for them," Dr. Rosen said. "Yet I approach this from the point of view of the comprehension of risks."
The best candidates for refractive lens exchange (RLE) are patients with hyperopia who are age 55 years or older, he said. Younger myopes have a greater axial length and will experience greater retinal stretching. Retinal detachment is one of the top concerns for myopic patients, although Dr. Rosen emphasized that outcomes from correction of retinal detachment are good.
The incidence of pseudophakic rhegmatogenous retinal detachment (RRD) in myopic eyes varies from 0% to 8% in the literature, and the mean cumulative incidence is 1.71% (one out of 58 eyes), Dr. Rosen said. Sometimes the detachment can occur 21 years or more after surgery, so this risk factor is something surgeons must explain thoroughly.
Lens extraction also increases the risk of posterior vitreous detachment in older myopic patients, he said, although the risk is lower in patients who have had a prior posterior vitreous detachment.
Surgeons must also emphasize that the procedure is permanent, unlike phakic lens implantation.
Options for replacement of the natural lens in these eyes include monofocal (with or without induced monovision), bifocal or accommodative IOLs.
An accommodative IOL utilizes several aspects of pseudoaccommodation, "trying to give patients the best of all worlds," Dr. Rosen.
Hyperopic eyes, in which LASIK is often not the best option, can also benefit from RLE but with fewer risk factors.
"Hyperopic eyes, in contrast to myopic eyes, show very low incidence of retinal detachment, and in our own series of 1,000 eyes, we've only had one retinal detachment," he said, noting that long-term research of this aspect is needed.