Eyeworld Daily News

14 | EYEWORLD DAILY NEWS | MAY 6, 2023 ASCRS ANNUAL MEETING DAILY NEWS A SCRS Refractive Day began with a session that ad- dressed preoperative "EQ" (emotional intelligence). Marguerite McDonald, MD, shared information for the patient who is in their "40s and frightened." Why are they frightened? Because they've begun to experience presby- opia, which is among the first signs of aging, she said. "For people who are in their 40s and frightened, there is no need to be frightened," Dr. McDonald said. "There are new options because sci- ence marches on." Dr. McDonald provided in- formation on several options. Presbyopia-correcting drops, as a non-surgical option, includes Vuity (1.25% pilocarpine, AbbVie/Aller- gan), which is FDA approved, and several that are in clinical trials. She also discussed monovision LASIK, which 48% of patients adapt to 1 week postop and 78% 8 weeks postop. PresbyLASIK, which aims to create multifocality in both eyes using different profiles, is not yet ap- proved in the U.S., but there are four platforms that are currently being or were studied in the recent past. Corneal inlays for presbyopia with synthetic materials were a failure, Dr. McDonald said, but more recent efforts are researching use of human corneal tissue and collagen. Finally, she brought up Optimal Keratoplasty (Opti-K, NTK Enterpris- es), which is entering Phase 3 studies in the U.S. and has the CE Mark in Europe. This is a procedure that temporarily increases near vision for 6 months with retreatment possi- ble after that time. The 2.5-second procedure delivers 16 paracentral spots that creates shallow spots of condensation and doesn't disturb the epithelium. Following, Rex Hamilton, MD, discussed patients who are "50s and Fabulous," showcasing the options for presbyopic hyperopes, myopes, and those with prior refractive sur- gery. Sumit "Sam" Garg, MD, took on the "60s and Savvy" patients who are candidates for refractive cataract surgery. The session then transitioned into discussing patient-guided decision making. Andrew Kao, MD, addressed the Type A/perfectionist. With these patients, he said, com- munication is key. It's important to understand the patients' goals, explain the surgery clearly, and have patience. It's also important, Dr. Kao continued, to set clear boundaries with realistic expectations. Dr. Kao also advised to not take things per- sonally, because these patients can seem critical. Nandini Venkateswaran, MD, shared her insights on a refractive surgery candidate who is indecisive. She started off with a video skit depicting how she works with such a patient. The indecisive patient often presents as anxious, asks many questions, takes notes, makes mul- tiple phone calls to the office, and vacillates between surgical options and having surgery all together, Dr. Venkateswaran said. Dr. Venkateswaran's advice to help put these patients at ease is to make the patient feel powerful in the room (as the physician, sit in a lower chair, make direct eye contact, take extra time, and use props), include a friend or family member in the dis- cussion, encourage patients to return for a second discussion, make your recommendation but empower the patient with resources, encourage a second opinion with a colleague, and consider, as the physician, whether the patient's personality makes him or her a good surgical candidate. Tal Raviv, MD, talked about the opposite type of patient—the complacent patient. Dr. Raviv also presented a video skit with a patient who wants a "basic" cataract surgery and how he describes to the patient what a "basic" cataract surgery would mean for them, in the process further finding out that the patient "just [wants] to do what I've been doing but better." Dr. Raviv said complacent patients seem to have a sense of self-satisfaction with a decreased sense of risk and less anticipation of possible problems, thinking that everything will turn out perfectly. These patients, he added, can be at risk for noncompliance. How does he approach these patients? With solid education, repetition, and confir- mation of their understanding of their options and decision. Dr. Raviv also thinks it's important to under promise, over deliver, and refer for a second opinion, if needed. Dr. Raviv's other advice is to make sure the procedure doesn't take away vision that the patient currently enjoys and avoid a high compli- ance-requiring procedure. Editors' note: The speakers have finan- cial interests with several ophthalmic companies. Preoperative 'EQ': managing patient stage/age and personality Dr. Kao shares how he handles the Type A/ perfectionist patient who is seeking refractive surgery and refractive cataract surgery.

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