Refractive
Spring 2025
by Liz Hillman
Editorial Co-Director
EyeWorld spoke with Roger Zaldivar, MD, MSc, MBA, about patient-reported outcome measures in general, as well as a relatively new digital health ecosystem he’s created to provide real-world, big-data insights on patient experiences with different IOLs and refractive procedures. Dr. Zaldivar said he doesn’t think most surgeons collect patient-reported outcomes in a consistent and systematic manner. He mentioned that while many of his colleagues gather this data for clinical studies, he views it as less reliable compared to real-world data because studies may not reflect real-world experiences. In prospective controlled studies, patients often don’t pay the standard fees and may have different expectations than those in real-world scenarios. Whether you’re tracking your individual outcomes in a manual way and using them to inform your future decisions or tracking your outcomes and analyzing them within a big-data system, Dr. Zaldivar said it’s important for surgeons to track patient-reported outcomes.
If you’re not measuring patient-reported outcomes, you might not be practicing solid, consistent medicine, Dr. Zaldivar said. You might be a great surgeon and do the best IOL calculations, but if your patients are not happy, there is something in the patient’s journey that is not fitting properly, he continued. Most of the time, if a patient is not happy, Dr. Zaldivar said there is something you are missing. He said it’s important to gather data and relate it to the patient to understand and learn.
In 2020, Dr. Zaldivar introduced Revai, an advanced data entry solution that incorporates a patient-reported outcomes approach and an analytics tool that utilizes AI. ICL Guru is a prime example of Revai’s capabilities, already integrated into the platform as an AI-powered ICL sizing calculator based on extensive experience of more than 23,500 ICL procedures spanning 30 years. According to Dr. Zaldivar, ICL Guru is boosting surgeons’ confidence in ICL technology by achieving accurate vault results. This is made possible by the system’s use of AI to recognize various eye configurations, drawing on decades of ICL surgery knowledge, and its ability to standardize optimized UBM images through advanced software development.
Beyond ICLs, Revai has been amassing a collection of real-world patient-reported outcomes for IOLs. This data is providing information on how different IOLs are functioning in the real world and match with patients’ anatomy and lifestyle, Dr. Zaldivar said.
Revai’s data (n=3,600) on premium IOLs has shown that patients with advanced-technology IOLs who experience dysphotopsias do not necessarily undergo true neuroadaptation to these visual disturbances, but rather what Dr. Zaldivar calls neuro-resignation. Even though there is a modest improvement in photic symptoms, the glare and halos are still perceived but are accepted more naturally. Night driving disturbance scores were similar at 1 month and 1 year, but overall satisfaction with the IOL improved.
Dr. Zaldivar also pointed out data in the system that compared trifocal and EDOF IOLs that has shown the intermediate vision, which is supposed to be stronger with an EDOF, is weaker than intermediate vision with trifocals, at least in patients’ perception.
Dr. Zaldivar said data collection from patients is conducted via email at 1 week postop, 1 month, 3 months, 6 months, and 1 year. The questionnaires ask about patient satisfaction with the surgeon, spectacle independence at different distances, level of dysphotopsia, whether their expectations are met, quality of service, confidence in the physician, etc.
Dr. Zaldivar is working on building up data sets and applications in Revai for retina, glaucoma, dry eye, cataract, and refractive surgery.
“We are learning from the patient in a very standardized and automatized way, and that’s what’s driving improvement in what we’re doing with patient selection—which conditions in the eye are playing an important role that we have to pay more attention to,” Dr. Zaldivar said. The advancements in software and AI over the past 2 years have propelled us to a higher level, he continued. This is due to the availability of accurate patient satisfaction data, which can be combined with various aspects of the eye, including aberrometry, pupil size, lens power, and chord mu. By incorporating all these factors, we are able to draw new insights and conclusions, he said.
About the physician
Roger Zaldivar, MD, MSc, MBA
Instituto Zaldivar
CEO, RevaiCare LLC
Mendoza, Argentina
Relevant disclosures
Zaldivar: RevaiCare
Contact
Zaldivar: zaldivar@zaldivar.com
