Eyeworld Supplements

W hen I ask cataract surgery patients if they are interested in seeing without glasses after surgery with advanced technology options, in general, one-third say "yes," one- third say "no" and they are fine with wearing glasses, and one-third say they "don't know." Education is key in all of these patients. When all is said and done, in my practice, 40% of patients choose the "premium implant/surgery, minimize glasses wear" journey, and 60% choose the "traditional implant/surgery, wear glasses" journey. I start out these discussions on options with a lesson in accommo- dation. I want patients to under- stand the function of their natural lens. I call it their "reading lens." It makes sense to them when I explain how the reading lens got stiff in their 40s and they then needed read- ing glasses or bifocals for near work. I go on to say, "That's the first thing that goes wrong with your reading lens." I explain that the second thing that goes wrong with that same reading lens is why they are in my clinic today: "Your lens is now cloudy and is blurring your vision … it has become a cataract." I want them to understand that these two things (loss of reading ability and loss of clarity) went wrong with their lens because it helps them to understand that certain lens implant technologies will replace only one issue (the cloudiness) and certain implant technologies will replace both issues (the cloudiness and the reading function). Many patients in my practice who are interested in advanced technology choose a multifocal or an accommodating lens because they want quality near, intermedi- ate, and distance vision. I explain to patients that multifocal technology is probably the most powerful form of near vision that we can give them. They may experience some nighttime glare or subtle loss of contrast sensitivity in certain low light situations though, so if they seem to be perfectionists or they believe they will have trouble adjusting, they may want to con- sider accommodative technology. I educate them that accommodative technology will give them the best low-light image quality, such as nighttime driving, but that the near may not be as powerful as they like and thus readers may be needed for some small print reading. This same accommodative technology in its current state can give seamless vision at all three distances if the patient is willing to accept a small amount of monovision, say –0.75 D. No technology is perfect, though, and patients are often very comfort- able accepting that as long as they are told all the facts preoperatively. If you are operating on a cataract patient who is younger than 60 years old, it is important to remem- ber that he or she often has some accommodative ability. For example, if you operate on a 47-year-old cataract patient who is in bifocals and you don't tell him that with a monofocal implant he may be using a trifocal for intermediate vision 2 by Vance Thompson, MD Talking to patients about refractive cataract surgery advanced technology options " Often, patients feel the investment is even more worth it when they learn that the advanced technology implants' reading and intermediate vision does not deteriorate over the years like their natural lens did." Vance Thompson, MD Education is key for all patients, regardless of their stated preference. Patients are receiving a new level cataract procedure with today's technology. continued on page 7 May 2014

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