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Patient assessment affects premium lens selection
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Proper patient assessment and education before implantation of premium IOL can begin years before a patient ever enters a surgeon’s office. Technology has improved outcomes for patients to the point where they can achieve spectacle freedom with high-quality, functional vision, OSN Cornea/External Disease Section Editor Elizabeth Yeu, MD, told Ocular Surgery News.
“We do our due diligence to educate our community and referral doctors. ... That education may start 3 years before I actually meet them,” Yeu said.
Having a standardized, easy-to-understand process when patients first come to the clinic is important to educate them about the surgical options and teach them the basics of the procedure. The language should focus less on the technology, and more on the refractive outcomes, Yeu said.
Assessment of eye health
At the initial 2- to 3-hour visit, a technician assesses the patient for astigmatism with LED-based topography to determine the orientation of the posterior corneal curvature. Patients also undergo a Lipi-Scan (Johnson & Johnson Vision) assessment of meibomian gland function to determine their potential for dry eye disease.
“Then, we look at a snapshot of the macula if they are interested in advanced technology lenses or if they have potential retinal problems,” Yeu said.
Patient satisfaction largely depends on proper patient selection based on pre-existing conditions, their needs, realistic expectations, and patient knowledge of the different premium optical lens designs and performance of multifocal IOLs, according to a study by Salerno and colleagues.
During the examination, the technician explains astigmatism, focusing on the goals of the technology, Yeu said. When the counselor meets the patient, the counselor discusses whether correction of the astigmatism is warranted.
“For us, anything over 0.3 D of astigmatism warrants correction,” Yeu said.
For patients with about 1 D or more of astigmatism, then a lenticular correction with a toric option is discussed, although all options that give a range of vision are reviewed, Yeu said.
After assessment and counseling, the patient undergoes pupil dilation while watching a short educational video in which the surgeon introduces herself and gives a brief overview of the cataract surgery procedure. Then the patient meets the surgeon and undergoes a brief examination, Yeu said.
Before Yeu meets the patient, she has in hand a summary detailing the patient’s eye dominance, height, profession, hobbies, interests and goals for the procedure.
“With that, combined with the objective data — the LipiScan, the topographies, the OCT images — I know a lot of the innards of the patient and some patient-specific characteristics before I walk into the room. It helps me in the discussion about options. I can then make a true formal recommendation,” Yeu said.
Assessing a patient’s outcome after the first eye is also important, Yeu said. A patient needs to know about potential symptoms, particularly night vision symptoms, that can occur after surgery. For the less than 2% of patients whose night vision symptoms are severe, such as seeing sparkles around lights, glare or halos, the surgeon has options to address the symptoms. Patients may adapt to the symptoms, or the surgeon may recommend a change in the type of lens or mix of IOL technologies, for example, implanting a monofocal lens in the dominant eye or exchanging the IOL as needed in the nondominant eye, Yeu said.
The entire process is much different than it was even 2 years ago when surgeons were tempering patient expectations leading into their surgery, she said. Now, with extended depth of focus lenses and better technology, the quality of vision is much higher with fewer potential complications. – by Robert Linnehan
- Reference:
- Salerno LC, et al. Taiwan J Ophthalmol. 2017;doi:10.4103/tjo.tjo_19_17.
- For more information:
- Elizabeth Yeu, MD, can be reached at Virginia Eye Consultants, 241 Corporate Blvd., Suite 210, Norfolk, VA 23502; email: eyeu@vec2020.com.
Disclosure: Yeu reports she is a consultant for Johnson & Johnson, Carl Zeiss Meditec, Alcon, Bausch + Lomb, TearScience and Allergan.