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Cover Focus | Sep 2015

Keep Up With the Changing Visual Needs of Younger Patients

In this population, it is even more crucial than normal to tailor IOL selection to patients' lifestyles.

Alan Koh Kok Khiang, MD, MBBS, MS(Ophth)

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.

Cataract surgery and refractive lens exchange (RLE) have become increasingly popular among patients as elective surgical options to achieve spectacle independence. Due to lifestyle and environmental factors, some patients develop early cataract, requiring surgical intervention at a younger age than the norm. When diagnosed with mild or early cataract, many patients around age 50 years or even younger opt for surgery early. Other patients, even those with a mostly clear crystalline lens, see RLE as an attractive option to solve their refractive problems.

These patients tend to be young, affluent, well educated, and demanding. They lead active lifestyles, and, thus, they look for advanced surgery techniques and IOLs to fit their vision needs. Achieving spectacle independence or any measure of it for this population of patients is especially crucial; however, it also can be challenging due to their various profiles of lifestyle, geographic location, age, working status, stage of cataract, and clinical contraindications.

CHANGING NEEDS

Several social and environmental factors contribute to the changing needs among our younger cataract surgery and RLE patients. Understanding the factors listed in Tailoring IOL Selection can aid surgeons and their staffs in helping patients choose the IOL model that will provide the greatest benefit.

Sadly, there is no perfect IOL suitable for all types of patients. Therefore, it is important to set appropriate expectations preoperatively. Patients must understand that no IOL choice—no matter what advanced characteristics it offers—can guarantee 100% spectacle independence. Rather, the proper IOL choice can help reduce one’s dependence on glasses.

CONCLUSION

A surgeon, much like a tailor, must customize IOL selection based on the factors discussed herein. In order to excel in this task, surgeons and their staffs must understand what the patient’s needs and desires are prior to cataract treatment, match it with the options available, and educate the patient on realistic expectations with that IOL. An educated patient with the right expectations should have minimal complaints and a high satisfaction level after surgery. n

Alan Koh Kok Khiang, MD, MBBS, MS(Ophth)
• Consultant Ophthalmologist, Vista Eye Specialist, Malaysia
• alan@vista.com.my
• Financial disclosure: None

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