13 EyeWorld Asia-Pacific | March 2025 CATARACT Once you’ve narrowed down lens options based on the patient’s ocular situation, you move onto assessing the needs of the patient. “You need to interview the patient to assess their needs based on their vocation and avocation,” Dr. Rubenstein said. “Are they interested in distance vision only, and therefore happy with wearing glasses for computer, intermediate, and near, or do they want to have less of a need for glasses and be able to see distance plus intermediate vision without correction, or lastly, do they want uncorrected vision for distance, intermediate, and near? That’s a discussion you have with the patient based on your perception of their needs and their declared needs.” Dr. Rubenstein said that with more experience in these conversations, you get more of a feel for what the patient may want and need for their best performance. “After a while, you start assessing the patient almost the moment you walk into the room. You can see what type of person they are and what they might want. Then comes the discussion, trying to figure out what the patient’s needs are. You use your experience to target your discussion to what you think is the best fit for the patient. Obviously, that’s going to vary based on the experience of the surgeon.” At this point, the discussion gets into the lens options that are available and that match the patient’s ocular needs as well as their personal refractive desires. Even if a patient is not eligible for a certain type of lens (or if a certain type of lens is inadvisable due to personality or perceived intolerance of dysphotopsias), Dr. Rubenstein still mentions these lens options briefly because patients have often heard about them from their own research or from friends/ family who have experience with them. Dr. Rubenstein said that in his practice, he is the one who talks about lens specifics with the patient, but he does have a surgical coordinator who goes into detailed questions about the surgery, scheduling, and payment based on the IOL recommendation that Dr. Rubenstein has made. As more lens options have come to the market over the last two decades, Dr. Rubenstein said it has been important for the doctor to drive the conversation to the best choice for the patient, based on the ocular assessment and the patient’s visual desires. “You don’t have time to talk about every possible option, and too many options can get confusing to the patient. So I think you have to make an editorial decision yourself. … You have to think about what information you are going to present in an honest and fair way to give the patient the best informed consent possible and hopefully get them to have their best visual result and be as happy as possible.” Going forward, Dr. Rubenstein said there is likely a place for visual simulators to demonstrate the visual experience from the different IOLs as well as increasing pre-education for patients. He said industry is getting more involved in what they can provide surgeons to serve as their partners in providing pre-educational materials for patients about their lenses. John Berdahl, MD, Refractive Editorial Board member, shared what evolving treatments and techniques in ophthalmology he is excited about: “In cataract surgery, presbyopia and adjustable IOLs make every waking moment more convenient, and sublingual sedation can remove IV pokes but more importantly unnecessary fentanyl use while still ensuring patient comfort during cataract surgery.”
RkJQdWJsaXNoZXIy Njk2NTg0