Preoperative Considerations for Cataract Surgery – Episode 12

For the cataract surgery patient, it’s important to prepare the patient for success with cataract surgery by making sure that they understand their options. As cataracts progress, a slow reduction in visual acuity occurs resulting from increasing lens opacification. But visual acuity utilizing high contrast targets only tell part of the story. A number of our patients with cataracts have
a much more difficult time driving in the evening because of excessive glare, and require more light when they read. It’s important to educate patients on how their cataracts progress in order to prepare them for what to expect as their cataracts get worse. Optometry is truly the first touch point for most patients when the decision is made to proceed with cataract surgery. Usually, this occurs when the vision is 20/40 or worse. Exceptions to this rule can be made for those with better Snellen acuity but significant reduction in functionality. So it’s incumbent upon optometry to be at the forefront of understanding the options available for our patients. Years ago, simply telling patients that they needed cataract surgery and referring them to a cataract surgeon was enough. But today, there are a variety of lens options for a patients that has truly evolved into an opportunity that provides patients greater refractive freedoms. Toric intraocular lenses are now available to correct up to 4 diopters of refractive cylinder, which is a significant  advancement in the recent years. It’s rotated into place by the surgeon to the patient’s exact specifications. Additionally, advances in multifocal and intraocular lenses provide even greater options for a refractive correction of our patients. There are two large categories of multifocal intraocular lenses – those that are apodized and those that are accommodative. Apodized lenses provide diffractive optics that simultaneously focus both distance and near optics on the retina. It additionally changes the percentage of those optics that enter the eye based on the size of the pupil, providing a truly intelligent design. Accommodating intraocular lenses move anteriorly through the ciliary body contraction. This provide patients additional power for near vision through the movement of the lens. With the apodized diffractive intraocular lens, don’t be surprised if the lenses aren’t center in the pupil. As you know because of angle kappa, many individuals don’t view the world through the center of the pupil but rather through a region that is nasal to the center of the pupil. Because of this fact, most surgeons will attempt to center the apodized lens over the patient’s line of sight. So don’t be surprised, as this seen in this picture, if the center of the lens is nasally displaced in the pupil. Make sure to take the time to educate your patient about cataract progression so they truly know what to expect. Understand the intraocular lens options that are available for your patients and understand what to expect with multifocal lens placement. Ultimately, this will optimize our patients visual outcomes and enhance their lives, which is ultimately why we do what we do.

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