Young surgeons need to be knowledgeable about premium IOLs
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The hardest part of cataract surgery is picking the right lens for the right patient. Young surgeons need to know the many options that are available on the market and discuss them with their patients.
“Even if you are not going to offer advanced-technology IOLs, your patients need to know what those options are. I see a lot of second-opinion patients who have had perfect outcomes with a single-distance lens but are very upset because they were not told about other options,” Christina Prescott, MD, said at Real World Ophthalmology.
Toric IOLs are a good way to start with premium lenses but require accurate and consistent preoperative measurements.
“I do a Pentacam (Oculus) in all my patients and make sure that refraction, biometry, tomography and keratometry all line up,” Prescott said.
For proper IOL alignment, she likes using the RoboMarker (Surgilm), a simple device that allows for precise marking on the cornea with crisp lines that stay on postoperatively for up to 2 hours.
“Another option is using the ORA (Alcon), but I personally prefer to get good preoperative measurements, good marks and use the ORA only in rare conditions,” she said.
Presbyopia-correcting lenses are constantly improving, options are many, and patient selection is key.
“What you must think about is the range of vison your patients need for their occupation, hobbies and daily activities. The eye must be healthy, and patients must have realistic expectations,” Prescott said.
Despite improvement, presbyopia-correcting IOLs still have a trade-off: The wider the range of vision, the more optical aberrations there will be. If a patient wants perfect vision at one specific distance, a monofocal lens is a better choice.
Finally, surgeons who implant premium lenses should be able to offer postoperative enhancement facilities.
“You need a plan to correct residual refractive error. If patients pay for a premium IOL, they don’t expect to wear glasses,” Prescott said.
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Prescott C. So much to do, so little time: How to incorporate premium lenses into early practice. Presented at: Real World Ophthalmology; April 2, 2022 (virtual meeting).
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