Lens exchange is next wave of refractive surgery
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BOSTON — Refractive lens exchange technology has reached the point where patients are taking notice, making it the latest wave in refractive surgery, according to a speaker here.
In the Steinert Lecture at Refractive Day at the American Society of Cataract and Refractive Surgery meeting, Stephen G. Slade, MD, FACS, said there have been two major waves in refractive surgery that drove patient excitement: incisional keratotomy and LASIK. Patients knew about these procedures, and a lot of people had them done.
He said lens-based refractive surgery, whether ICLs (STAAR Surgical) or other lenses, is the third wave.
“Why is it that we’re doing all this [refractive lens exchange]?” he said. “Because we have the lenses that are finally good enough, and patients get it. They say, ‘Whoa, you mean if I have this done, I don’t have to have cataract surgery later?’”
Earlier surgery at a younger age generally means that patients do better. Slade said increasing age is a risk factor for many cataract surgery complications, and younger patients have a better chance of experiencing visual acuity improvements than older patients.
When thinking about lens exchange, Slade said it is important to follow the trends of baby boomers. They led the LASIK boom and are driving the next wave of refractive surgery.
“This is the Botox, Viagra, Rogaine, collagen, Restylane generation,” Slade said. “Baby boomers view aging as weakness. We are not going to go easy into that good night. We’ve got most of the money, my generation, and we are willing to spend it on ourselves.”
These patients demand perfect vision but often have unrealistic expectations and do not necessarily understand the risk, Slade said. Uncorrected visual acuity at distance drives satisfaction in these patients.
Because patients have individual needs, there is not one perfect lens that will work for everyone.
“Part of and perhaps the most important thing we do is match the lens to the patient,” he said. “You’ve got to talk to these people. You’ve got to understand what their expectations are, their wants, what they do for a job.”
While physicians are interested in data, Slade said patients want to hear anecdotes and personal stories. For many younger patients, this is their first major surgery, and it is important to guide them through the process.
“You know what works the best in my experience?” Slade said. “Tell them what lens you would put in, what you would have if you were them.”
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Slade S. Refractive lens exchange. Presented at: American Society of Cataract and Refractive Surgery meeting; April 5-8, 2024; Boston.
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