ONLINE EXCLUSIVE
ASCRS News
November 2021
David Chang, MD, and Kendall Donaldson, MD, MS, chaired the in-person ASCRS 20/Happy in 2021 program in New Orleans, Louisiana, an expansion of the ASCRS Master Class in Refractive Cataract Surgery. Panelists included Quentin Allen, MD, Zaina Al-Mohtaseb, MD, Richard Tipperman, MD, Steven Dell, MD, Rudy Nuijts, MD, PhD, and William Trattler, MD. The CME program included presentations on a variety of refractive topics.
During her presentation on “An evidence-based look at presbyopia-correcting intraocular lenses,” Julie Schallhorn, MD, stressed the importance of understanding patients’ specific visual needs. You can’t just tell a patient that a certain IOL will work for them if you don’t know exactly what their visual needs are, she said, adding that patients needed to be counselled that they may experience more visual phenomena with a multifocal or EDOF as compared to a standard monofocal lens. While this is not a guarantee, Dr. Schallhorn said it’s usually the case.
She shared data comparing some of these visual phenomena, visual acuity, and other factors. But she noted that in some instances, it’s hard to directly compare the lenses because each one uses a different patient-reported outcomes questionnaire.
Dr. Trattler spoke about preoperative screening for underlying conditions that may impact visual outcomes and what’s essential. In order to achieve great outcomes, he said that the first step is determining who is a candidate for which lenses. Residual refractive error can have a severe impact on premium lens outcomes. He mentioned the importance of screening for and treating dry eye/MGD/blepharitis and performing topography and an OCT of the macula preoperatively.
In a discussion of preoperative tests, Dr. Tipperman noted the importance of sharing images from different tests with patients. He finds that when patients see the images, it helps them better understand why they may or may not be a candidate for a certain lens.
When discussing a patient’s lens options, Dr. Trattler said he narrows it down to just two or three, trying to optimize the choices for the patient because it can be overwhelming if there are too many options. Dr. Donaldson agreed that it can be overwhelming and said she will make a specific recommendation based on her opinion of the best lens for the patient after reviewing preoperative images and discussing the patient’s goals and needs.
While discussing the value of aberrometry, Dr. Donaldson explained how the technology accounts for three primary sources of error: posterior corneal astigmatism, surgically induced astigmatism, and torsional changes (head tilt).
Dr. Tipperman’s presentation covered managing unhappy patients. He noted that the most important thing is to maintain a good relationship with the patient, and make sure they know you care about them. To do this, he suggested actively listening, empathizing, and validating and showing that you understand their symptoms, in addition to taking your time with the patient.
The 20/Happy ASCRS Master Class in Refractive Cataract Surgery provided practical information to help surgeons make the best decisions with regard to refractive cataract surgery. Experts provided an array of insights on issues from preoperative testing through postoperative enhancements with a goal of helping other surgeons navigate the refractive cataract surgery process.
Registrants of the 20/Happy in 2020 program can log in to see the full 20/Happy in 2021 module. The entire 10-module, 20/Happy ASCRS Master Class in Refractive Cataract Surgery is archived online and can be accessed for a nominal subscription fee.
Relevant disclosures
Donaldson: Alcon, Carl Zeiss Meditec, Johnson & Johnson Vision, LENSAR
Schallhorn: None
Tipperman: Alcon
Trattler: Alcon, Allergan, Bausch + Lomb, BVI, Carl Zeiss Meditec, Johnson & Johnson Vision, Kala Pharmaceuticals, Oculus, Sun Pharmaceutical
Contact
Chang: dceye@earthlink.net
Donaldson: KDonaldson@med.miami.edu
Schallhorn: jschallhorn@gmail.com
Tipperman: rtipperman@mindspring.com
Trattler: wtrattler@gmail.com
