5 Questions with Fritz H. Hengerer, MD

1.What do you find most challenging about refractive surgery?
With so many treatment options at our disposal, it can be challenging to identify the refractive solution that will provide the best possible outcome for a patient. At Ruhr University Eye Hospital, we are fortunate because we can draw from a number of options, including commercially available premium IOLs, accommodating IOLs that are under development, phakic IOL technology, and laserbased treatments. Determining the best fit can be challenging.

2.What surgical techniques or technologies do you find the most exciting and promising for refractive surgery?
We are particularly excited about the Light Adjustable Lens (LAL; Calhoun Vision, Inc., Pasadena, California), because this IOL offers all facets of spherical, toric, and combined adjustments, and it can be used to treat presbyopia. The fact that we can adjust the LAL to each patient’s needs, or change the refraction if the patient is unhappy, is a significant development. We are also interested in novel techniques for treating presbyopia with a femtosecond laser in combination with the Kamra inlay (AcuFocus Inc., Irvine, California).

3.What are the challenges and rewards of being head surgeon at a university hospital?
From a clinical perspective, the primary challenge is managing comprehensive patient care as well as a busy surgical practice that includes glaucoma, cornea, cataract, refractive, strabismus, retina, and trauma. From a scientific perspective, I am given the opportunity to have personal contact with national and international colleagues, which allows constant exchange of experience. I also have the opportunity to teach students and show my enthusiasm for the subject area while developing young colleagues. Finally, there are my research projects, which currently include further development of the LAL, 23-gauge vitrectomy combined with microincision cataract surgery, the Vidion Anti-Neovascular therapy system (NeoVista, Inc., Freemont, California), and determining the best study participation ratio.

1.What do you find most challenging about refractive surgery?
With so many treatment options at our disposal, it can be challenging to identify the refractive solution that will provide the best possible outcome for a patient. At Ruhr University Eye Hospital, we are fortunate because we can draw from a number of options, including commercially available premium IOLs, accommodating IOLs that are under development, phakic IOL technology, and laser-based treatments. Determining the best fit can be challenging.

4. How do you manage patients with unrealistic expectations?
Difficulties arise when there is a significant difference in perspectives between the surgeon and the patient, or when patients’ expectations are heightened due to information that they received from friends, family, or the Internet. My approach involves calmly and rationally explaining the possible options to patients, the expected outcome, and the risks. It is of utmost importance to listen to what patients are telling you so that you really understand what lies behind their expectations. We always emphasize the facts and focus on underpromising and overdelivering. When you take this approach, most patients are pleased with the results. For the really difficult patients, we may involve other family members and encourage the patients to seek a second opinion to reinforce what I told them initially.

5.What is your most memorable international experience?
My most memorable international experience is receiving the Goldener Löwe (Golden Lion) award at the German Ophthalmic Surgeons meeting in 2008 for a video on my surgical technique and pearls for posterior optic buttonholing.