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Refractive Surgery | Sep 2009

5 Questions With Carlos Verges, MD, PhD

Dr. Verges is Professor and Head of the Department of Ophthalmology, CIMA, Universitat Politecnica de Catalunya, Spain.

1. What is the current focus of your research?

At present, my team is focused on research associated with various aspects of cataract and refractive surgery. These include diagnostic systems, surgical techniques, equipment, new technology, new lens designs, and analysis of visual perception.

2. What current options for presbyopia correction do you find to be the most effective?

Because presbyopia involves many factors with interpersonal variations, it is difficult to find a technique or procedure that is effective in every patient. Thus, it appears more logical to choose the best solution according to the patient's habits, preferences, and the anatomy and physiology of his eyes.

Following this premise, we may consider the classic options of glasses or contact lenses or choose a surgical intervention, such as corneal laser, corneal or scleral implants, and IOLs. In our clinic, we prefer to attempt a certain grade of monovision. We achieve this in young presbyopes by treating the cornea with an aspheric laser profile.

If the patient's crystalline lens exhibits significant changes, we prefer to use refractive lens exchange. In our experience, we have had a high rate of success; however, some patients complain of halos or problems while driving at night. To avoid these complications, newer pseudoaccommodating IOLs appear to provide better results than previous designs.

Combination of premium IOLs with excimer laser ablation compensates for accommodation; however, this technique has its own problems, including aberrations and prismatic effects induced by the center of the different optical surfaces. For this reason, we are cautious when we evaluate this possibility.

3. How do you manage patients with unrealistic expectations?
The best way to satisfy patients is to provide them with an honest explanation of what is possible to achieve with vision correction. It is important to also present this information with a positive attitude. From the outset, I carefully inform patients of all appropriate options and solutions that are available. I explain to them that although a certain procedure may improve their vision, it cannot give them back a utopian youth. Patients usually understand that, although everlasting youth does not exist, we can improve their optic situation to a great extent.

I am always truthful with patients about the limitations that we may encounter in the process. Eyes are like many other parts of the body; we can improve their function, not offer a miracle cure.

4. How has your involvement with the International Council Steering Committee of the International Society of Refractive Surgery of the American Academy of Ophthalmology (AAO) influenced your view of the need for European participation at US-based meetings?
There are profound differences in lifestyles and values between patients in Europe and the United States. Because of these differences, I believe that it is essential to encourage a fluent exchange of information between Europeans and Americans at ophthalmic meetings. Doing so exposes individuals as well as nations to different approaches that can enhance and extend current approaches and ways of thinking.

5. What do you consider to be your greatest personal achievement outside of your profession?
I believe my greatest personal achievement is the outlook on life that I learned from studying philosophy. I look at others not as a means, but as an end in and of themselves. Because of my positive view of life, I believe that the world offers enriching experiences to each of us—our patients, family, and oneself.