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: Why ODs should comanage cataract surgery

The sheer numbers provide much of the obvious evidence of why optometrists need to be involved in the comanagement of cataract surgery. Currently, about 3 million cataract surgeries are performed each year. By 2050, however, more than 50 million people in the U.S. are projected to have cataracts, according to the American Academy of Ophthalmology.

Cataract surgery has tangible and intangible benefits for our patients, including a 40% decrease in mortality, a 16% reduction in the odds of having a hip fracture and a 13% decrease in the risk of having a car accident (AAO).

What about the all-important conversation about premium procedures and implants? It is important not to prejudge your patients’ desire and ability to pay out-of-pocket for the technology they want for their lifestyle. Many seniors can afford treatment!

It is important to note that, according to Impact Business Partners:

  • 70% of the nation’s wealth is held by those 50 years old and older;
  • adults 65 years and older have an average net worth of $170,000;
  • seniors have a comprehensive safety net most other adults do not have; and
  • seniors fear loss of sight more than any of the other sense.

IOL technology continues to evolve, and it is vital that optometrists work closely with patients to determine their specific visual needs. Aspheric lenses that use full- or apodized-diffractive multifocal technology to correct presbyopia seek to improve on previous visual outcomes seen with previous refractive implants. These lenses increase spectacle independence and improve visual quality.

Alcon’s AcrySof IQ Restor Multifocal IOL features an apodized-diffractive optical structure, meaning it is designed using gradual step heights toward the periphery of the diffractive zone. Tecnis Multifocal IOLs (Johnson & Johnson Vision) have a full-diffractive profile on the posterior surface of the optic. The relief height of the diffractive rings results in an equal light distribution to distance and near, regardless of pupil size or add power.

The recently introduced Tecnis Symfony is an extended-depth-of-focus IOL. Although it also uses diffractive technology, it does not split the light into two focal points. The implant’s proprietary echelette design produces a pattern of light diffraction that elongates the focus.

The Crystalens AO (Bausch + Lomb) is an accommodating implant that requires less neuroadaptation compared to multifocals and is less sensitive to lens misalignment and pupil size. The implant provides superior intermediate vision and quality of vision over a more natural range by using 100% of light at all times.

Next time, I will explore why it is so important for patients to have their astigmatism corrected when they have cataract surgery.


American Academy of Ophthalmology. Cataract surgery infographic. Posted June 10, 2014. Accessed April 11, 2018.

Impact Business Partners. Baby Boomers will control 70% of disposable income. Posted Feb. 22, 2016. Accessed April 11, 2018.