There have been great advancements in cataract surgery over the past several years, and 2013 has been another stellar year, with the introduction of several technologies to further improve outcomes in refractive cataract surgery. These include advanced intraoperative aberrometry for more accurate IOL power selection and lens positioning, femtosecond laser technology for some aspects of cataract surgery, and new toric IOLs to better serve our astigmatic patients.
My philosophy is this: No matter how good a surgeon I think I am, I know that I can improve my performance, both in terms of objective results and in the quality of my interaction with patients.
It is important to collect your own data and regularly analyze outcomes. Otherwise, you do not know where you started or whether your cataract surgery results have improved. The game changer for me this year has been the incorporation of intraoperative aberrometry with streaming refractive data (ORA System with VerifEye; WaveTec Vision). The ORA System was already an advantage—and something I considered standard of care in my practice. However, the addition of streaming refractive data has made it easier to determine when the eye is ready for data capture and facilitates the accuracy of limbal relaxing incisions and toric IOL alignment. I use it to help me determine the best IOL power in every refractive cataract surgery case (Figure 1).
The ORA System with VerifEye has improved the accuracy of my overall refractive outcomes by more than 25% to 30%, to the point that they are now equal to or better than LASIK outcomes. According to a recent analysis of personal data, 95% of eyes are now within ±0.50 D of intended target postoperatively, and 72% are within ±0.25 D, with a tight mean standard deviation. This level of accuracy has decreased my enhancement rate to less than 2%—a huge improvement from the 10% or greater enhancement rates we used to consider par for the course with premium IOLs.
The improved IOL power selection and results hold true in all of my refractive cataract surgery patients, but the benefits have been even greater for postrefractive surgery eyes and those getting toric implants. The ability for the ORA System to measure total eye refractive error—including any posterior corneal astigmatism—in the aphakic eye and to take surgically induced astigmatism into account has completely changed how I treat astigmatism (Figure 2).
My results with toric IOLs have improved so much that now the Trulign Toric (Bausch + Lomb) is my most frequently implanted premium lens (Figure 3). I will no longer perform postrefractive or toric IOL surgery without VerifEye because I consider it essential to a good outcome in these eyes.
In addition to the streaming refractive data introduced with VerifEye, the ORA System has gotten faster, with capture and processing speeds of about 5 seconds, and the large number of eyes in the company’s database (125,000 and counting) is used to continually optimize IOL constants. Better outcomes have improved patient satisfaction and word-of-mouth referrals for my practice, so my premium IOL conversion rate and revenue have grown substantially. Moreover, the ongoing improvements in the system provide me with reassurance for the future that my investment was wise.
Implementing new technologies that objectively improved outcomes was one area of success I enjoyed in 2013. But I also believe that improving how we relate to patients has a real impact on their subjective experience. Modern cataract surgery is really a refractive procedure, and today patients who undergo surgery have high expectations for their postoperative vision. In this setting, the leading factor in our success or failure is communication between doctor and patient.
I have learned that it is crucial to get to know your patients and their expectations, as well as the limitations of the technologies you offer them. This year, one important thing I have implemented is to ask patients to repeat what I have said in their own words. This seemingly small step helps me to ensure that their understanding of the information is correct.
In 2013, I raised the bar with surgical technology and my expectations for patient communication. The result has been greatly improved outcomes and happier patients.
P. Dee Stephenson, MD, FACS, ABES, FSEE, is in private practice with Stephenson Eye Associates, in Venice, Florida. Dr. Stephenson states that she is a member of the speakers bureau for Aaren Scientific, Inc.; Bausch + Lomb; and WaveTech Vision. She may be reached at e-mail: firstname.lastname@example.org.