Cataract
Winter 2024
by Mitchell Weikert, MD
Cataract Editor
Bidding goodbye to the current calendar year and ushering in the next often inspires reflection on the past and anticipation of progress as we look toward the future. In this spirit, it’s difficult to think of a more apt theme for this issue of EyeWorld than “Evolving treatments and techniques in ophthalmology.” Many of our “tried and true” methods for managing ophthalmic disorders are being revisited, rethought, and updated as we leverage new insights into their underlying pathology to better understand what’s working and what can be improved in our approaches to cataract, refractive, cornea, and glaucoma surgery. In the area of cataract surgery, this EyeWorld issue casts a wide net, covering the diverse topics of patient counseling in IOL selection, lessons learned with the Light Adjustable Lens (LAL, RxSight), and allergies to materials used in cataract surgery.
Bidding goodbye to the current calendar year and ushering in the next often inspires reflection on the past and anticipation of progress as we look toward the future.
Over the last decade, we’ve enjoyed incredible expansion in the variety of IOLs available for implantation with cataract surgery. However, as is often the case, the benefits of this expansion have been accompanied by numerous challenges. More than ever, we’re faced with increasing burdens in education (for ourselves as well as our patients), preoperative assessment, and consent complexity. Rosa Braga-Mele, MD, Kendall Donaldson, MD, and Jonathan Rubenstein, MD, provide advice on how to navigate these hurdles as they describe their approach to selecting the most appropriate IOL(s) for each patient. They also provide guidance on how to clearly and efficiently discuss the myriad of choices with patients and outline their wish list for how this process could be improved.
Also in this issue, Sumitra Khandelwal, MD, Bryan Lee, MD, JD, Neda Shamie, MD, and Taylor Strange, DO, dial down on one specific IOL in our tool kit as they impart their lessons learned with the LAL. All four surgeons have broad experience with the IOL and have successfully implemented it in their refractive cataract practices. In addition to Dr. Khandelwal’s perspective on incorporating the LAL into an academic practice, the others impart their tips for streamlining the adoption of this IOL in any practice to fully realize its potential for improved refractive accuracy. Recommendations for patient selection, IOL selection (LAL vs. LAL+), fellow eye surgical timing, refractive targeting, postop treatment timing, the role of optometric team members, and setting appropriate patient expectations are covered.
Allergies, whether real or perceived, present a significant and frustrating impediment to the seamless flow of cataract surgery. They may limit our use of medications, narrow our choices for anesthesia, dramatically expand the consent process, increase patient anxiety, and undermine patient confidence in the surgical team. Derek DelMonte, MD, and Alice Epitropoulos, MD, explore these various issues as they present their approaches to managing allergies encountered with cataract surgery patients. In addition to providing guidance on separating true allergies from simple intolerance, they specifically address allergies to lidocaine, betadine, sulfa, and latex.
We hope this issue of EyeWorld will help foster an appreciation for the continued progress of our subspecialty and will offer some practical tips to navigate common challenges that we’ve faced in the past but will be better equipped to manage in the new year.
