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Optimize RLE outcomes through careful patient selection
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The recommendation for cataract surgery is probably one of the easiest referrals we make as optometrists – for good reason. With more than 3 million Americans undergoing cataract surgery annually, it has become an impressively safe and effective procedure.
Combining increasingly adept surgical skills, precision instrumentation, a wide array of IOL options and efficient postoperative treatment regimens has meant one thing. The eye care community is creating a whole new generation of pseudophakic patients who are not only seeing incredibly well, but doing so with far less dependence on postoperative correction. As a result, it is not surprising that studies in the U.S. as well as around the world are trending toward cataract surgery at an earlier age and with more patients electing second eye surgeries.
Further fueling these trends are two demographics: an older set who is interested in enhancing their vision in an effort to remain cognitively engaged and to mitigate falls and fractures, as well as a younger (read: Baby Boomer) demographic who remains extremely active and simply refuses to retire quietly. Regardless of their motivation, it is the sheer number of procedures that drives innovation: femtosecond lasers, intraoperative aberrometry, premium channel IOLs, bilateral same day surgery and, yes, eventual in-office cataract surgery. With cataract surgery enjoying such an incredible “run,” it all begs one question: Why wait?
Given the impressive track record of lensectomy and IOL implantation, one could easily argue its utility in a much broader cross-section of the population. Simply put, should we not consider those in need, even if they have clear lenses? Or is it time the eye care community take a more adoptive approach to refractive lens exchange (RLE)?
We all see our share of patients for whom RLE makes sense. Those with significant lenticular-based higher-order aberrations, moderate to high myopia and hyperopic presbyopia and individuals with significant (albeit regular) astigmatism, all, arguably, warrant consideration. However, before we become intoxicated with the prospect of RLE for all, we cannot forget one simple tenet. While patients from every one of these ametropic categories may well be RLE candidates, not every patient within each category is a viable candidate.
In the 2015 landmark article “The changing pattern of cataract surgery indications” by Lundström and colleagues, the authors very aptly noted: “The decision on timing of cataract surgery is a complex one, and the one-size-fits-all approach does not work.”
In much the same fashion, RLE is anything but a one-size-fits-all surgery. As refractive care stewards of many potential RLE candidates, optometrists are well suited to help patients make the right decision. We know their eyes from cornea to retina, the dynamics of their ocular surface and, in many cases, the intangibles – things like tolerance, expectations and demeanor. It is only logical we play a key role in the pre- and postoperative care of the RLE patient.
In this month’s issue of Primary Care Optometry News, I encourage you to take a good look at Dr. Marc Bloomenstein’s article entitled “Consider refractive lens exchange in patients with presbyopia”. One of optometry’s most authoritative RLE clinicians, Marc provides sage advice for patient selection as well as for optimizing outcomes. I am sure you will find it a worthy read.
- Reference:
- Lundström M, et al Ophthalmology. 2015;122(1):31–38; doi: 10.1016/j.ophtha.2014.07.047.