Set expectations early to ensure high patient satisfaction in refractive cataract surgery
Jackson MA, et al. How to keep the promise of no glasses following cataract surgery. Presented at: Hawaiian Eye; May 8-14, 2021; Wailea, Hawaii.
Jackson reports he is a consultant to Alcon, Allergan, Avedro, Avellino, Bausch + Lomb, BlephEx, Carl Zeiss Meditec, EyePoint, Eyevance, Glaukos, iOptics, J&J Vision, Kala, Lensar, Novartis, Ocular Therapeutix, Oculus, Omeros, Science Based Health, Sight Sciences and Sun Pharma.
WAILEA, Hawaii — Keeping the promise of “no glasses after cataract surgery,” begins and ends with preoperative preparation and setting of expectations, according to a speaker at Hawaiian Eye 2021.
“You need to establish your options, and then you need to establish expectations for each option. That is probably the most important thing,” Mitchell A. Jackson, MD, said.
Mitchell A. Jackson
Jackson recommends categorizing patients into three external tiers depending on their overall vision goals and the IOLs that may be appropriate for those options. Patients in the basic category will end up likely requiring glasses full time. “Legal to drive” patients will receive a custom surgery with an Light Adjustable Lens for up to 2 D cylinder, or a toric lens implant for patients with more than 2 D cylinder, Jackson said. These patients will likely require glasses for intermediate and near vision tasks.
These patients will receive either the Vivity, Symfony, PanOptix, low add multifocals with toric or non-toric IOL options.
“I’m going to give them a basic option and an advanced option,” Jackson said. “I never give them like five options, because then I will never do surgery in the first place.”
Each patient must be evaluated to ensure they are a good candidate for premium IOL options. “But then you have to make sure the patient is a perfect candidate for a premium option, and that is our due diligence,” Jackson said.
Patients should be evaluated for the presence of ocular surface disease and macular pathologies. Corneal topography and corneal quality should also be evaluated, Jackson said. Use a fourth generation IOL formula and set realistic expectations, Jackson said.
Jackson uses a lifestyle vision questionnaire to get a glimpse of the patient’s lifestyle, activity level and personality type to plan which type of lens to use.
To get as close as possible to the patient’s refractive goal, Jackson recommends considering a Light Adjustable Lens because of its ability to be adjusted postoperatively.
The newly announced UV protection reduced concerns for patient compliance, Jackson said. In addition to not increasing glare and halos, the lens allows patients to achieve the best uncorrected visual acuity at all distances, with customization to fit each patient’s needs, Jackson said.
“So, remember: Perfect objective criteria, perfect subjective criteria and consider adjustable IOL technology. Keeping the promise of no glasses really starts and ends preoperatively,” Jackson said.