Josh Johnston, OD, FAAO, evaluates the nuances integral to success with new technology for premium cataract surgery. He is the clinical and residency director at Georgia Eye Partners in Atlanta. Johnston reports he is a consultant to Alcon, Allergan, Bio-Tissue, Johnson & Johnson Vision and Shire.

BLOG: What goes into a premium cataract surgery experience?

Patients are looking for cataract surgery outcomes that do more than enable their current lifestyle; they want even better vision than before via an enhanced refractive experience.

Eye care providers, therefore, are tasked with offering the appropriate advanced technology from the implant to the option of laser cataract surgery to get patients to that goal.

It’s important that we view all of these products as tools that help deliver on the promise of cataract surgery today. Patients seek the freedom to continue to lead active lives and enjoy their full range of activities and hobbies with no visual constraints.

Big ‘wows’: Family of lenses

Having a solution for every patient and being able to offer a wide range of technology or options, like with the Tecnis family of lenses (ie, Symfony and Tecnis Multifocal, Toric or Monofocal, Johnson & Johnson Vision), means that surgeons can customize vision based on the individual needs of the patients. When choosing the right presbyopia-correcting IOL, surgeons need to meet patients’ expectations for visual quality, the range of vision and, of course, dysphotopsias.

Using an approach like Personalized Vision, with a Symfony and Tecnis Multifocal lens, for example, or Restor Multifocal (Alcon) with the newer-generation Restor ActiveFocus, can ensure patients achieve their postoperative visual goals.

Laser precision

The incorporation of the femtosecond laser in cataract surgery further elevates the refractive opportunities associated with the procedure. Using femtosecond laser systems like the Catalys, (Johnson & Johnson) or LenSx (Alcon), surgeons can reliably and predictably create capsulotomies that enhance surgical precision, thereby raising the bar in terms of nailing outcomes. The laser corrects astigmatism elegantly at the time of surgery, eliminating the need for limbal relaxing incisions.

Patients have come to accept that modern surgeries incorporate the laser, and it makes sense to them that the technology would be associated with benefits compared with manual procedures. Surgeons also talk about the dramatic “wow” factor that happens for patients after laser cataract surgery.

Smaller wows: Drops are out

Smaller things make a difference to patients as well within their overall surgical journey. We all know that the drop regimen around cataract surgery is problematic for patients in terms of its frequency and complexity, which has an adverse impact on compliance. Ultimately, a lack of adherence can lead to an increase in negative events. The burden of this cycle on patients and staff cannot be overstated.

In response, industry has introduced various approaches to needing fewer drops. One example,

Omidria (phenylephrine and ketorolac injection 1%/0.3%, Omeros), can be added to the irrigation solution preoperatively. It is FDA-approved to prevent intraoperative miosis and reduce postoperative pain.

Imprimis’ intravitreal injection of Tri-Moxi is a proprietary compounded mixture of triamcinolone and moxifloxacin. Surgeons using this and similar approaches report moving to fewer drops or completely dropless regimens for many patients.

In yet another approach, the first intracanalicular insert delivering dexamethasone (Dextenza, Ocular Therapeutix) was approved late last year to treat postsurgical ocular pain for up to 30 days with a single administration. The company is also seeking an indication for inflammation. This is just the beginning of “drop disruption” in this space.

The cataract process is a journey for patients — a journey that offers them a reward of great vision at the end. But it’s up to us to make sure they know about the advanced options available to truly deliver on the promise of refractive cataract surgery.

Editor' note: This article was updated to correct the name of the Tri-Moxi intravitreal injection.