Pacific Cataract and Laser Institute optometrists Brooks Alldredge, OD, and Kerri Norris, OD, FAAO, discuss comanagement of cataract, refractive, glaucoma and corneal surgical cases, including surgical concepts and postoperative complications. The authors report no financial disclosures.

BLOG: Cataract surgery in the patient with retinal disease

Not long ago, a patient with both cataracts and retinal disease remained exclusively under the care of a cataract surgeon and retina specialist. Not anymore.

For many reasons, including increased knowledge and skill level, availability of advanced imaging, and demographics (the number of cataract patients is increasing rapidly while the number of cataract surgeons and retina specialists is not), optometrists have played an active role in the care of the cataract patient with retinal disease. And there’s every reason to predict that role will only increase in the future.

This month, we will focus on general considerations and principles that we have found beneficial in these often challenging cases. In next month’s post, we will focus on strategies for several specific retinal conditions and surgeries that we see commonly in practice. Our interest is in the practical – the bits of information and advice that frequently go unsaid in optometry school and residency training.

General considerations, principles

Accurate, timely and understandable communication between comanaging optometrist and cataract surgeon is always important. However, more complex cases require even more attention in both detail and accuracy. And the addition of a retina specialist who is treating active disease places even more demand on the time and skills of the primary care eye doctor to provide patient counseling that is complete and understandable. That’s in addition to coordinating care among all providers.

To begin with, we encourage observing and learning the surgery and treatment techniques of both cataract and retina specialist alike. From the cataract surgeon, get answers to these four questions:

— What type of sedation and anesthesia is used? Why?

— Where are the main and port incisions located?

— How much time does it take the surgeon to complete a routine case?

— Finally, how deep in the anterior chamber does the surgeon prefer to do his or her phacoemulsification?

Why would you be interested in this last question? Cataract surgery is art, a balancing act between several factors, particularly speed and phaco depth, and the best surgeons are always learning and changing. A deep phaco increases the risk of capsular tears, while a more anterior phaco typically results in more corneal edema early in the post-op course. One isn’t necessarily good or bad.

But the answers to each of these questions help predict the most expected postoperative findings and guide the treatment of complications, such as where to perform a paracentesis wound burp for a very high pressure.