Tailoring IOL Selection
Lower average age of developing cataract or seeking cataract surgery. Most patients who seek cataract surgery or RLE at a young age are working individuals who spend considerable time on a computer for work or leisure (especially social media). They also drive often, remain active socially and physically, and like to travel and shop.
Refractive issues. Patients with high refractive errors who develop presbyopia are especially frustrated by the compounded visual difficulties and the need to adapt to multifocal spectacles. With a loss of confidence in LASIK among many patients, more are turning to RLE when it is presented as an option.
New technologies. With the introduction of laser-assisted cataract surgery and new IOL technologies over the past decade, surgeons and patients have become more confident that they can achieve safer and better results after cataract surgery and RLE. This is especially true of younger patients, who tend to be more confident in the results of the latest technologies.
Later retirement age. The extension of working years is a factor in IOL selection. Many people are now working well beyond what used to be considered retirement age (60 or 65). These individuals are more likely to want to maintain good reading and intermediate vision when they opt for cataract surgery.
Degree of cataract. The type and degree of cataract can also affect the decision of what lens to choose, as patients with denser cataracts ten to be more forgiving in terms of postoperative visual results. These patients are more focused on their visual acuity, and improvements are welcome. However, the newer generatio of patients with early cataracts and those who opt for surger for refractive purposes focus more on spectacle independence. These patients tend to be less forgiving and more focused on small side effects and minor deficiencies.
Postrefractive surgery. Patients who have previously undergone corneal refractive surgery treatments such as LASIK, when beset by presbyopia, are more receptive to considering RLE as a viable option for cosmetic reasons. After years of enjoying good vision, LASIK patients find it hard to accept having to wear glasses again.
Alan Koh Kok Khiang, MD, MBBS, MS(Ophth)
• Consultant Ophthalmologist, Vista Eye Specialist, Malaysia
• Financial disclosure: None