No such thing as ‘one size fits all’ in refractive cataract surgery
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When matching a patient to an IOL before refractive cataract surgery, it is important to recognize that there is no such thing as “one size fits all,” according to a speaker at the Women in Ophthalmology Summer Symposium.
“What we like to do in our practice is we really like to hear the story of our patients. We spend a lot of chair time listening to the patient’s visual needs,” Neda Shamie, MD, said.
By sitting down and listening to the needs of each patient, Shamie is able to establish credibility, and patients know the effort is being made to make the decision about lens choice as easy as possible.
Shamie likes the Light Adjustable Lens (LAL, RxSight), as long as the patient is able to commit to the necessary adjustments after the procedure.
“In post-refractive patients, this is, in my mind, hands down, the best, and ... it’s a wonderful premium option to offer our cataract patients a refractive surgical outcome,” Shamie said.
Current-generation trifocal IOLs are less dependent on light conditions and less prone to glare and halos, but patients should still be educated about their possible occurrence, she said.
Patients such as pilots or engineers, Shamie said, typically do well with the LAL set for monovision. A patient who is a “realistic want it all,” someone who does not want reading glasses but is OK with nighttime glare or halos, typically does well with a trifocal IOL. Shamie recommends extended focus lenses or the LAL for active and engaged readers.
“The take-home message is that there is no ‘one size fits all.’ The ideal scenario is really, if there is a referring doctor, for them to offer the possibility of premium lens choices so the patient comes in with the expectation that there will be options available and that you as the surgeon hear the patient’s story and matchmake them to the best option possible,” Shamie said.
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Shamie N. Updates in IOL selection in refractive cataract surgery. Presented at: Women in Ophthalmology Summer Symposium; Aug. 26-29, 2021; Amelia Island, Florida.
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