Kendall Donaldson, MD, and Jennifer Loh, MD, led a session at ASCRS Refractive Day highlighting the past, present, and future of cataract refractive surgery.
Eric Donnenfeld, MD, first spoke about the history of refractive cataract surgery and shared what he considers to be four landmark moments in refractive cataract surgery.
The first was in 1949, with the first intraocular lens implantation, and Dr. Donnenfeld noted the contributions of Sir Harold Ridley, adding that the IOL spurred the birth of ASCRS.
Next, he moved on to the year 1967, noting the contributions of Charles Kelman, MD, and the invention of phacoemulsification.
He jumped to 1983, speaking about Kenneth Hoffer, MD, and his idea for the first presbyopia IOL. The first diffractive multifocal IOL came in 1987, and these developments started a new era of IOLs.
Source: ASCRS
Finally, Dr. Donnenfeld mentioned 1999 and the first optical biometer in Germany by Zeiss. We were able to take IOL calculations from less than 50% to up to 80–90% accuracy, he said, and that allowed us to have new IOL formulas, which were key to improving accuracy.
He concluded by saying that the past of refractive cataract surgery was great, the present is wonderful, and the future looks even better.
Neda Shamie, MD, presented on “lens logic,” offering pearls for tailoring IOLs to patients. She said her presentation would “bring it down to the clinic and what it takes to bring technology to patients and convince them that what we recommend to them is the right choice for them.” With the pearls she shared, she said she has been able to increase conversion rates in her practice. More than 55% of her practice’s patients choose advanced-technology IOLs (ATIOLs).
Dr. Shamie spoke about matching patients to the correct lens option and streamlining the process. Empower the team, referring doctors, and the patients with knowledge about ATIOLs. Additionally, she suggested lessening the premium package options, training technicians in triaging patients to the most likely IOL choice, optimizing diagnostic tools to assess for candidacy, and managing expectations pre- and post-surgery.
First and foremost, know your tools, Dr. Shamie said. It’s important for you to know the lens options, but even this is not enough. She suggested planting the seed for patients ahead of time. Your website is a critical tool for this, and the referring optometrist needs to know the information you use. Dr. Shamie uses her personal Instagram page to promote cataract and refractive surgery as well.
She suggested consolidating the options to avoid decision paralysis. You should know about all the technology, but you don’t need to offer all of it to patients. Dr. Shamie spends more time hearing about the patient’s visual needs and lifestyle and evaluating their eyes to make sure they match the lens she’s thinking about.
Getting to know your patient will help in counseling, Dr. Shamie said. A lot of it is history and knowing how the patient uses their eyes. Information on the patient’s visual demands, reading correction, prior refractive surgery, and other comorbidities is also key.
Narrow down the advanced IOL options for patients seeking spectacle independence, sharing which options might be best for which patients. For example, for a hyperope who wears glasses at all distances, typically, a trifocal or EDOF would be best. For a myope who is accustomed to reading without glasses, you can’t take that from them, she said, suggesting a trifocal. In patients with a history of LASIK/PRK/RK/SMILE, she suggested the Light Adjustable Lens (LAL, RxSight) unless they can’t take that path for other reasons. For those who have a history of monovision with contacts and love it, an LAL or EDOF with mini-monovision would work well. In irregular corneas, Dr. Shamie said to use a small aperture ideally in the non-dominant eye and possibly an LAL in the dominant. These cases are a little more involved, she said.
Dr. Shamie stressed that there’s no such thing as a one-size-fits-all approach. In the ideal scenario, the patient would come in already exposed to the possibility of ATIOLs, and the IOL choices would be narrowed down to one or two early in the consultation. Additionally, a trust relationship would be established early and a proper informed decision made, with the vision outcome personalized to the patient’s needs.
Financial disclosures
Donnenfeld: AbbVie, Alcon, Bausch + Lomb, BVI, Johnson & Johnson Vision, Katena, Nordic Pharma, Oculus
Shamie: Alcon, Bausch + Lomb, LENSAR, RxSight, STAAR Surgical, Zeiss
