Be cautious if considering use of premium IOLs in patients with glaucoma
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WAIKOLOA, Hawaii — Surgeons need to consider the risks and possible refractive outcomes before implanting a premium IOL in a patient with glaucoma, according to a presentation at Hawaiian Eye 2022.
Nathan Radcliffe, MD, said that when a patient with glaucoma who already has a premium IOL experiences a problem, the IOL is rarely the issue.
“I never remove the premium IOL because as bad as the glaucoma gets, I just don’t think that that’s really the patient’s problem,” he said. “Sometimes the field has taken their central vision, and the glaucoma’s the problem there, not the lens.”
Therefore, when considering implanting a premium IOL in a patient with glaucoma, Radcliffe said surgeons need to be careful.
“We don’t know a whole lot from a data standpoint about what these lenses really cause in terms of problems,” he said. “We always want to be cautious.”
The first thing to consider, Radcliffe said, is the foveal sensitivity.
“If it’s above 30 dB or 32 dB, it’s pretty normal,” he said. “Always be a little worried if someone is missing that center part of their vision there on the field.”
However, the most important thing to consider when looking at the success or failure of a premium IOL is whether the patient can achieve the refractive target. That becomes more difficult when a patient has exfoliative glaucoma.
“Exfoliation and glaucoma can really take off on you,” Radcliffe said. “Zonule problems and exfoliation get worse with time. Glaucoma defects get worse with time, particularly exfoliation.”
Radcliffe said research has shown that patients with pseudoexfoliation glaucoma are 7.3 times more likely to experience a refractive surprise after phacoemulsification.
The best to way to handle these issues is to proceed with caution.
“Informed consent is going be the best tool here,” Radcliffe said. “Milder disease, the age of the onset of the exfoliation, as well as a patient’s life expectancy are huge factors that can turn someone who wouldn’t be a candidate into a candidate or vice versa. Ultimately, I think diffractive technology seems wise, but a costly lens may let a patient down if the target is off.”
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Radcliffe N. What about premium IOLs? Presented at: Hawaiian Eye 2022; Jan. 15-21, 2022; Waikoloa, Hawaii.
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