PUBLICATION EXCLUSIVE: Several options available to fix refractive misses in cataract surgery

Welcome to another edition of CEDARS/ASPENS Debates. CEDARS/ASPENS is a joint society of cornea, cataract and refractive surgery specialists, here to discuss some of the latest hot topics in ophthalmology.

As cataract surgery becomes more of a refractive procedure, patient expectations for a better refractive result have escalated. Dealing with refractive misses has become a source of frustration to many refractive cataract surgeons. This month, Denise M. Visco, MD, and Cathleen M. McCabe, MD, discuss their approaches to dealing with these problems. We hope you enjoy the discussion.

Kenneth A. Beckman, MD, FACS
OSN CEDARS/ASPENS Debates Editor

Five-step process to decrease need for enhancements

Refractive eye surgery is any eye surgical procedure used to improve the refractive state of the eye, thereby decreasing dependency on glasses or contact lenses. With the arrival of femtosecond lasers into the cataract surgical market, continued innovation has improved the processes of refractive cataract surgery tremendously. But refractive surgical procedures hold expectations from patients that are different from standard cataract surgery. Often our work does not end after 1 day in the operating room, and fulfilling our commitments can be time-consuming and difficult.

Successful surgeons will generally maneuver through five basic steps with refractive cataract surgery. First, we educate patients. A connection and understanding between what patients want and what surgeons can do are extremely important. Most will agree enhancing an unrealistic expectation is virtually impossible. Second, we measure. Accuracy in treatment decisions relies on quality measurements with diagnostic devices, calculations using suitable formulas, and the proper applications of nomograms. Third, we treat. The more we can link our accurate measurements, formulas and nomograms to the treatment profile on the patient’s eye, the better the outcome. Fourth, we track. Known as a lagging indicator, outcomes must be tracked so we can make better decisions in the future. By tracking results and making adjustment to our processes, we can systematically decrease the number of misses. Lastly, we fix. Enhancements will be necessary for those patients who fall short of their target and are unhappy with the results of their refractive cataract surgery.

Click here to read the full publication exclusive, Cedars/Aspens Debates, published in Ocular Surgery News U.S. Edition, November 25, 2016.