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BLOG: A letter to my future cataract surgeon

ByJohn A. Hovanesian, MD, FACS

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Dear Doctor,

I really appreciate your taking care of me, but I do have a few more questions. I know you are eminently qualified to do my cataract surgery because you’ve done thousands of procedures. Of course most patients don’t ask these questions, but isn’t it true that the difference between good and great surgeons is that great surgeons are well prepared in case things don’t go well?

If my lens nucleus is rock hard, will you be prepared to use a device like miLOOP (Iantech) or potentially convert to small-incision extracapsular cataract surgery? You are familiar with these, aren’t you? Should you be before you do my surgery?

I’m also really excited about the presbyopia-correcting lenses we are planning, but if I don’t have an intact capsule, do you have a three-piece lens back-up option that you could place in the ciliary sulcus and do optic capture with the haptics in the sulcus and the lens in the bag?

And how familiar are you with pars plana vitrectomy? Don’t many experts agree this is the best approach in case I have significant vitreous loss? You do have small-gauge vitrectomy handpieces for your phaco machine, a handy MVR blade in your OR and the know-how to use them both, don’t you?

And what if there’s no capsule support at all? Will you be resorting to an anterior chamber IOL? Many of us pretty much gave those up in the ’00s. Instead, would you be comfortable gluing in an IOL or using the Yamane technique to fixate the lens in the posterior chamber, where it might be better tolerated?

I know you have a fantastic track record, and these kinds of complications are rare. But I picked you because I hoped that you would get me a good visual outcome, even if the unexpected happens. I appreciate that learning these extra skills must take a lot of time, effort and expense, even though you will hopefully rarely call on them. Thank you for having that dedication. It means a lot to me because my eyes are important.

Disclosure: Hovanesian reports he is an investor in Iantech, which makes the miLOOP device. He reports no other relevant financial disclosures.