In the white hot spotlight: controversies in presbyopic IOL surgery

Focusing on contentious questions

Practitioners here will question hot-button issues, such as whether accommodative IOLs like this CrystaLens really accommodate Source: John F. Doane, M.D.

The upcoming session on “Controversies in Presbyopic IOL Surgery” to be held at the 2010 ASCRSASOA Symposium and Congress in Boston is not your typical course, according to moderator John F. Doane, M.D., cornea and refractive surgeon, Discover Vision Centers, Kansas City. In the session slated for Mon., April 12, at 1 p.m., there are no scheduled talks. Instead, a panel to include Eric D. Donnenfeld, M.D., Stephen G. Slade, M.D., Steven J. Dell, M.D., Karl G. Stonecipher, M.D., Carlos Buznego, M.D., William B. Trattler, M.D., and Y. Ralph Chu, M.D., will take questions from the audience.
Opening the floor

“What we do is set up what we think are the top 20-25 topics and go from start to finish,” Dr. Doane said. “We try to get through what we think the attendees would most want to hear, then we open the floor to them to ask any questions and we just go down the panel.”
This year Dr. Doane thinks that some of the discussion is likely to center on the contraindications to presbyopic IOLs, specific instances where practitioners may have encountered problems, and what lenses are good in these scenarios. In addition, he thinks that nuts and bolts issues will also come into play. “We might talk about the marketing do’s and don’ts, or what you should do to prepare for surface issues such as for dry eye patients who are undergoing surgery,” Dr. Doane said. “We might also have a few case studies where the patients have complicated issues and you have to determine what you do now.” In addition, Dr. Doane expects that practitioners will likely share their experiences with various presbyopic lenses and discuss the up and down sides of these IOLs.
He stresses that the approach here will be anything but ordinary. “It’s not going to be the typical course where there are six speakers who each get 15 minutes, with two to three minutes of answering questions after each speaker,” Dr. Doane said. “This is a panel discussion on what we consider to be the hot topics for presbyopic IOLs.”
Dr. Doane finds the interactive approach to be exciting. “Answering the attendees’ questions is always the most fun because they have specific instances that come up that are germane to every ophthalmologist,” he said.
Controversial areas

Some of the issues that Dr. Doane expects to arise are the latest presbyopic IOLs and what combinations seem to be working best for surgeons, what percentage of patients can tolerate multifocality, and whether or not accommodative IOLs really accommodate. He thinks that mixing and matching lenses will likely be a hot issue during the session. Dr. Doane expects some of the discussion to center on whether or not mixing and matching can be done with good outcomes and in concert with that, whether or not practitioners must match lenses 100% of the time.
In addition, controversial patients may also be discussed during the session. Dr. Doane sees such patients as those with early age-related macular degeneration, as well as those with normal eyes who are seeking purely presbyopic correction. “What are the landmines associated with treating the pure presbyope who is at –1 D or –2 D and who just wants near correction?” Dr. Doane asked. “What are the pitfalls that you can run into with those patients?” Also, Dr. Doane expects to cover enhancement strategies for residual refractive error. “That’s always an important part,” he said.
Dr. Doane hopes that practitioners will come away from the session with the knowledge that the use of presbyopic lenses is a process. “You have to look at the full strategy,” he said. This strategy ranges from implanting the lens to taking care of astigmatism and residual refractive error to looking out for conditions such as macular edema and dry eye. “I think that the essence of the course is taking the patient from ‘Yes, I want to have the surgery’ to ‘Yes, I’m happy,’ which is a lot of work on the patient, staff, and surgeon’s part,” Dr. Doane said. “It’s not like that with LASIK where generally you do the surgery and the patient is happy forever.”
Overall, despite the controversies that will be highlighted in the session, Dr. Doane stresses that the presbyopic arena is one worth diving into. “We’re on the front end of the baby boom generation who are getting interested in or benefiting from presbyopic IOLs,” he said. “If there is ever a time to jump on board, this is it. These patients will be walking into the doctor’s office soon, there is no doubt about that.”

Editors’ note: Dr. Doane has financial interests with Bausch & Lomb (Rochester, N.Y.) and Calhoun Vision (Pasadena, Calif.).

Contact information

Doane: jdoane@discovervision.com