Gordon Johns, MD
PCLI—Medical Director

Over the last several years significant advances have been made in cataract surgery that reduce risk and give patients more options. With these improvements, patients are demanding even better visual outcomes. To meet expectations, we need your help.

Communication has always been the cornerstone of comanagement and as we work together to fine-tune surgical techniques, feedback becomes even more important. We need data from your post-op exams. This will enable us to perform slight adjustments that will make patients even happier with their vision.

The increased success of cataract surgery has brought increased expectations. For years cataract patients were happy to simply see better. They may have worn glasses since high school so having to wear them for a few more years after surgery was not considered a hardship. But with a decade of laser vision correction behind us, many baby boomers facing cataract surgery want reduced dependency on glasses.

When small amounts of lenticular opacity begin to fog their vision, boomers are not happy. They are seeking lens replacement sooner then ever and many want emmetropia—no astigmatism and clear vision at all distances. So, cataract surgery has become refractive surgery.

High-tech phaco machines, diamond knives, superb hand instruments, and new lens implant designs are helping surgeons refine their techniques and improve outcomes. New options for astigmatism management and presbyopia correction are particularly exciting.

Astigmatism Options

• Limbal relaxing incisions (LRI)—provide safer and more predictable correction than astigmatic keratotomy.
• Toric IOLs—can correct up to 2.25 D of corneal cylinder but require precise alignment.
• Laser vision correction—when performed 2 to 3 months after cataract surgery offers the greatest precision of these options.

Presbyopia Options

• Monovision—where one eye is corrected for near and the other for distance is a very reasonable approach for select patients.
• Multifocal IOLs—offer excellent vision and consumer interest is surging, but proper IOL power selection is critical.

Optometric physicians play an important role in the success of these options by carefully listening to patients before helping them select solutions that match their lifestyle.

Our doctors are also available to help with this decision making process. As with refractive surgery, our medical team can provide another level of screening to help ensure proper candidacy.

Once an option is selected, surgeons must provide precise surgery, proper IOL power, and lens placement that optimizes final outcomes. To accomplish this, surgeons rely on pre-op measurements as well as analysis done on a wide base of post-op findings—to make sure the techniques utilized have a track record of successfully hitting the mark.

We strive to be as accurate as possible when measuring and selecting lens implants. But toric and multifocal implants demand a higher degree of precision. Patients want astigmatism-free emmetropia and we are working hard to reduce refractive surprises—when outcomes are more than .5 D off the mark.

Newer instruments are helping us acquire more accurate and consistent axial length measurements. And improved formulas are introducing additional data to help us more accurately cover a wider spectrum of eyes (i.e. long vs. short, flat vs. steep). However, since the science is not perfect, and IOL calculations always involve uncontrollable variables, comparison of actual post-op findings with our intended outcomes is a valuable exercise.

A key to helping patients achieve excellent vision after cataract extraction is for surgeons to adjust their techniques based on actual outcomes. For our purposes, we have found that the most valuable data comes from 4-6 week post-op exams—and we maintain a sophisticated computer data base of this information.

The info we request from you is as follows:

• UCVA Near (if multifocal IOL)
• Manifest Refraction
• Keratometry
• IOP
• Corneal Edema
• IOL Displacement/Position
• Macula (if changed from pre-op)
• Retina (if changed from pre-op)

Although some referring doctors have faithfully shared this information over the years, we have not been very assertive in our request. But we highly value your feedback and desire a lot more input than we have been receiving.