Gateways to Cataract Refractive Surgery: Managing Astigmatism and Beyond

Gateways to Cataract Refractive Surgery: Managing Astigmatism and Beyond

This promotional activity is sponsored by Alcon Laboratories, Inc. All of the speakers are paid Alcon consultants.

Cataract surgeons must commit to achieving emmetropia

WAIKOLOA, Hawaii – According to current literature, approximately 71% of cataract surgeons achieve outcomes within ±0.5 D of target,1 said Stephen S. Lane, MD, medical director of Associated Eye Care (Figure 1).

At an Alcon Laboratories, Inc.-sponsored Industry Expert Theater held during Hawaiian Eye 2016, panelists gathered to discuss the current state of cataract surgery outcomes, and the steps that ophthalmologists need to take, particularly related to astigmatism management, to meet patient demands.

Figure 1: Percentage of patients from Swedish National Cataract Register study who met refractive target within ±0.5 D.1

Adapted from data published in: Behndig A, Montan P, Stenevi U, Kugelberg M, Zetterström C, Lundström M. Aiming for emmetropia after cataract surgery: Swedish National Cataract Register study. J Cataract Refract Surg. 2012;38(7):1181-1186.

“Certainly in my practice, patient expectations are at an all-time high,” said Lane. “I think this is driven in large part from the very positive experiences that we have with LASIK, where essentially 93% to 95% of patients achieve 20/40 vision and are satisfied with their refractive surgical result.2,3 So, cataract refractive surgery outcomes need to be able to meet this same target, [and] what that means is a commitment on the part of cataract surgeons to try and achieve emmetropia for their patients.”

Improving astigmatism management takes equal parts of awareness, technique and technology, Lane told attendees. Awareness includes tracking surgical outcomes and establishing baseline characteristics for the practice, such as developing personalized A-constants based on IOL type and preoperative biometry.

Surgical technique also contributes greatly to personal A-constants, and, when honed properly, helps to minimize surgically induced astigmatism (SIA). Finally, said Lane, surgeons need the proper tools to achieve good outcomes.

“We have many options today in terms of the technology, from femtosecond cataract lasers that add the precision and reproducibility of our procedures, to surgical guidance and planning that improve the process and our confidence of being able to hit our targets, to intraoperative aberrometry that can empower us with real-time data to help us achieve improved astigmatic outcomes, especially in patients who have had previous corneal refractive surgery.”

 

Lane also mentioned the importance of toric IOLs to address higher degrees of toricity. These IOLs come in a wide range of powers to correct astigmatism in the majority of patients with cataracts.

In the end, according to Lane, proper astigmatism management comes down to identifying sources of variability in the preoperative, intraoperative and postoperative phases of the procedure. From preoperative astigmatism planning and manual transcription to cyclorotation, SIA management and IOL positioning, reducing and even eliminating inconsistencies will help surgeons move closer to emmetropic results for their patients. 

Click here to learn how a thorough surgical plan can help surgeons choose the best IOLs for patients’ visual goals.

References

  1. Behndig A, Montan P, Stenevi U, Kugelberg M, Zetterström C, Lundström M. Aiming for emmetropia after cataract surgery: Swedish National Cataract Register study. J Cataract Refract Surg. 2012;38(7):1181-1186.
  2. “LASIK Surgery Statistics.” Docshop.com. http://www.docshop.com/education/vision/refractive/lasik/statistics
  3. Solomon KD, Fernández de Castro LE, Sandoval HP, et al, Joint LASIK Study Task Force. LASIK world literature review: quality of life and patient satisfaction. Ophthalmology. 2009 ;116(4):691-701.

 

6/16  US-CRS-16-E-2234 

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