Optimizing Cataract and Refractive Outcomes: Maximizing IOL Technology

T hese refractive IOLs offer many advantages: They are more stable than any surface procedure, provide better visual optics than surface procedures, and offer the real ability to correct presbyopia. But they also have serious downsides: Patients often complain of glare, halo, and loss of contrast sensitivity. I consider them a high-wire act—when things go smoothly, they are great, but everything has to be perfect. There is a variety of treatable causes of glare, halo, and loss of contrast sensitivity. Dry eye is a common and easily treatable cause. This can be detected easily with stanThis problem is cured easily with the YAG laser. We also must include cystoid macular edema (CME) on this list. Once dubbed sub-clinical, CME has been made clinically relevant by the improvements in IOL technology and the evolution of phacoemulsification techniques. In my opinion, within six months, the use of a non-steroidal antiinflammatory drug (NSAID) on every cataract case— especially if a multifocal IOL is implanted—will be the standard of care. There are a few myths that have surfaced regarding refractive IOLs. One such myth is that patients gratefully will tolerate small errors in visual acuity after a refractive lens if it means they do not need glasses for distance or near vision. This is untrue. Today’s cataract patients are demanding and do not tolerate anything less than perfect. If you are considering becoming a refractive cataract surgeon, you have to be willing and able to treat these small refractive errors or your practice will not succeed. You must be willing to perform surface procedures for small refractive errors. Another myth is that CME is not common. CME is actually incredibly common. Studies suggest that more than 20% of patients who have routine cataract surgery and are prescribed post-operative prednisolone acetate alone will have ocuOptimizing Cataract and Refractive Outcomes: Maximizing IOL Technology