Because of the higher visual expectations of today’s cataracts patients, eye surgeons must accept that cataract surgery has become refractive surgery, says Eric D. Donnenfeld, MD, a cataract and refractive surgeon in private practice at Ophthalmic Consultants of Long Island (Rockville Centre, NY).

In a recent issue of EyeWorld, Dr. Donnenfeld offered these observations, comments and suggestions to other eye surgeons:

• For patients who want to avoid being dependent on reading glasses after cataract surgery, current options include: 1) monovision with monofocal intraocular lenses (IOLs), 2) accommodating IOLs, and 3) multifocal IOLs.
• Monovision provides good results for many patients, but it can reduce depth perception and increase glare and halos at night.
• Today’s accommodative IOLs generally provide good distance vision, but may not deliver enough near vision to give patients the amount of freedom from reading glasses they desire.
• Dr. Donnenfeld’s lens of choice for cataract surgery that reduces the need for reading glasses is an aspheric multifocal IOL. He feels multifocal IOLs provide the best range of near vision while also offering good distance vision.
• In clinical trials of the Tecnis Multifocal IOL (Abbott Medical Optics, Santa Ana, Calif.), 93 percent of patients achieved uncorrected distance vision of 20/25 or better and uncorrected near vision of 20/32 or better, and most patients reported spectacle independence for most daily tasks.
• Dr. Donnenfeld says surgeons should ask patients about their vocation, hobbies and daily visual demands, and assess their tolerance for glare and halos before recommending a specific presbyopia-correcting IOL for cataract surgery.
• In the Technis Multifocal IOL clinical trial, only a small percentage of patients noticed glare and halo after surgery.

Dr. Donnenfeld also said today’s presbyopia correction IOLs are far superior to earlier versions of accommodating IOLs and multifocal IOLs that were available even two years ago. He encouraged cataract surgeons to embrace new refractive cataract surgery technologies and techniques to deliver the “wow” factor patients are looking for after surgery.

SOURCE:  Cataract patients: refractive goals. EyeWorld. May 2009. (Supplement: Premium Clinical Options for Cataract and Refractive Surgery, sponsored by Abbott Medical Optics.)