Eyeworld Daily News

8 | EYEWORLD DAILY NEWS | MAY 18, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING Step up to the plate Preoperatively, ophthalmolo- gists need to consider patient selection, patient counseling, and the workup. From a patient selection standpoint, Jessica Ciralsky, MD, New York, New York, said that while everyone would like to see like a 20-year-old emmetrope (which is not yet achievable with available tech- nology), there have been great strides in the field of presby- opia correction. "And with these innova- tions come increased patient expectations," she said. Matching the appropriate IOL with patient needs and expectations may seem easy, Dr. Ciralsky continued, but in practice it can be difficult. When considering patient selection for a presbyopia-cor- recting IOL, Dr. Ciralsky said she thinks of subjective and objective factors. Subjectively, she starts with patient expectations. by Liz Hillman Editorial Co-Director T here are several factors preop, intraop, and postop that influence hitting a home run in refractive cataract surgery, and a Sunday symposium addressed these variables in detail. "If you want to hit a home run in refractive cataract surgery, you have to show up to the game. You have to want to do refractive cataract sur- gery," said Daniel Chang, MD, comoderator of the session, Bakersfield, California. "Traditionally, we think of refractive surgery as the convenience of not having to wear glasses, but it's more than just convenience in this case. I think it can be a matter of safety," he said. Presbyopia is common, inconvenient, and it can be profitable, Dr. Chang continued. And yet, presby- opia-correcting lens use has remained relatively low. He said he thinks what really drives utilization of these lenses is something other than money. He went back to the Hippocratic Oath, in which physicians vow to "first, do no harm." If this oath drives what we do, how do we do no harm in cataract surgery? he asked. When thinking about using a presbyopia-correcting lens, its risk/benefit profile is relative to what? "I would argue that when we do cataract surgery, pres- byopia-correcting treatment is not optional. Presbyopia can be treated either surgically or we're going to use glasses," Dr. Chang said. There are risks and ben- efits to both of these. While ophthalmologists spend a lot of chair time talking to patients about the risks/benefits of presbyopia-correcting lenses, Dr. Chang posited that the risk/benefits of glasses aren't discussed as regularly. "One thing to keep in mind is that safety is more important than convenience," he contin- ued. Bifocal glasses come with decreased edge-contrast sen- sitivity and depth perception, which can cause an increased risk of falling by more than 2.3 times. Greater than 1:3 falls in the elderly are related to mul- tifocal glasses, Dr. Chang said. He went on to present U.S. data that showed there were more deaths related to falls in the elderly than there were from breast cancer or prostate cancer. "Even Americans who fall who aren't injured, about one in three of them develop this post-fall anxiety syndrome," Dr. Chang said, which can be associated with a functional decline, depression, feeling of helplessness, social isola- tion, increased risk of falling, reduced activity, and more. "Again, there is a lot of mor- bidity and mortality related to falls." The cost of fall injuries in the U.S. in 2014 equated to $31 billion to the healthcare system, Dr. Chang continued, and it is expected to approach nearly $70 billion this year. He noted that the cost of falls related to multifocal glasses is about $10 billion worth of economic impact. The good news is that cata- ract surgery reduces the risk of falls by a third, and replacing bifocal glasses with single-vi- sion glasses reduces the risk of falls by up to 40%. "So how do we do no harm? First, we need to recog- nize the risk of bifocal glasses. This is not just one of conve- nience but it's one of safety," he said, adding that while ophthalmologists might not see the consequences of falls in their practice, they do happen. "The good news is, we can help prevent falls with the surgical correction of presbyopia." Hitting a home run with refractive cataract surgery continued on page 10 There are risks and benefits to both presbyopia-correcting lenses and multifocal glasses, but Dr. Chang said the latter's risks and benefits are not as discussed as they should be. Source: Daniel Chang, MD, screenshot from presentation

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