Too soon to throw in the towel: So many options for premium surgeons
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Mark Twain once said, “Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do.”
Similarly, Lindsey Stirling is known for her quote regarding throwing in the towel as follows: “I guess you never know what’s going to come at you in life, but the answer is never to crawl into a box and throw in the towel. There is good that can come from anything, even if it’s just a later laugh and a good story.”
Premium surgeons may ask why all the sentimental quotations, but on June 29, just about 2 weeks ago as of this writing, my airway closed as I experienced anaphylaxis from a CT scan IV contrast dye and saw my life nearly ending in just 120 seconds. Fortunately, a great ER team was nearby in this outpatient facility and saved my life. I woke up and spent the next 6 hours in the emergency department until I was safely discharged to home. So, I say to my fellow premium surgeons, you just don’t know when it is your time, and make sure you enjoy the time that remains.
As it pertains to my work life, I am happy to say, after 33 years in the business and 29 years in private practice, there are so many options for premium surgeons to make our patients’ remaining years of eyesight that much better.
Evolution of premium IOL technology
I had the opportunity to start inserting premium IOLs as far back as the late ’90s with the AMO Array multifocal followed by the first-generation Crystalens model AT-45 (Bausch + Lomb) in 2003, the next-generation Crystalens models AT50/52 (Bausch + Lomb) in 2007 and finally the Trulign toric version of the Crystalens (Bausch + Lomb) in 2013. The current generation Crystalens and Trulign still provide good options, especially in post-refractive surgery patients who have had prior radial and/or astigmatic keratotomy.
Simultaneously, multifocal IOLs evolved to high add and then low add technology with the ReStor and ActiveFocus (Alcon) IOLs and the Tecnis family of ZMB00, ZLB00 and ZKB00 (Johnson & Johnson) IOLs, allowing for mix and match options depending on the patient’s lifestyle needs.
Next came the extended depth of focus (EDOF) technologies with the enVista monofocal and monofocal toric (Bausch + Lomb) used for monovision purposes and the Symfony and Symfony toric (Johnson & Johnson), the latter requiring an exact end target of plano in the dominant eye and –0.25 sphere in the nondominant eye, unlike the originally marketed –1.00 sphere in the nondominant eye at launch. The EDOF technologies provided excellent distance and intermediate vision options but typically lacked the real good near vision needs. The approvals of the trifocal PanOptix (Alcon) and the trifocal-EDOF combo Synergy (Johnson & Johnson) in both the non-toric and toric options have provided for true excellent near vision capabilities postoperatively. Lastly, the Light Adjustable Lens (RxSight), with its adjustability and invisibility technology, can provide a patient with a short trial of monovision postoperatively to see if they desire such a lifestyle option.
The future continues to bode well for my fellow premium surgeons with true accommodating IOLs such as Juvene (LensGen) and refractive shape indexing technology to alter monofocal IOLs that have been implanted in the past. One other surgical option coming in the future will be for those patients with early dysfunctional lens syndrome (no true cataract) and presbyopia: Laser scleral microporation (Ace Vision Group) reduces ocular rigidity by uncross-linking the scleral collagen tissue and allowing for a true restoration of accommodation by up to 1.5 D, as seen in clinical trials in the Philippines and Panama. Once a patient develops a cataract, the effect of this procedure may potentially enhance that of an accommodating IOL once implanted.
The last 2 decades have provided many reasons not to throw in the towel as a premium surgeon. Life is too short — celebrate it and deliver it in a better way to our patients with all these premium options. I look forward to my next 20 years, as Mark Twain stated, both personally and as a premium surgeon. I also look forward to seeing many of you live at the upcoming eye conferences.
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: mjlaserdoc@msn.com.
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