Eyeworld Daily News

47 EW SHOW DAILY 2018 ASCRS•ASOA Annual Meeting, Washington, D.C. by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer In this regard, while questionnaires can be useful particularly in terms of reducing chair time, nothing beats directly interacting with patients—learning from their own mouths, in their own words things like how they feel about their vision, what they do in terms of work and hobbies, and how they feel about wearing reading glasses. She dis- missed the commonly accepted generalization of avoiding type A personalities, saying she has had such patients do very well. Rather, she emphasized managing patients' expectations, keeping them realistic, offering available options without promising outcomes. Also, rather than "personality type," patients should be evaluated for what she called "opathies": ker- atopathy, optic neuropathy, zonu- lopathy, papillopathy, maculopa- thy, and psychopathy. She defined psychopathy as being unreceptive to expectation management, the patient having fixed—perhaps even unrealistic—ideas of what her vision can and must be. One significant cause of dissat- isfaction even of carefully selected patients is residual refractive error. Elizabeth Yeu, MD, Norfolk, Virgin- ia, said these cases require a me- thodical approach—the cause must be found and treated if possible. The patient can be given specta- cles, relaxing incisions, laser vision correction, or even IOL exchange as appropriate. "Refractive cataract surgery is a commitment that can yield great satisfaction, even if the patient is initially unhappy," she said. EW Editors' note: This symposium was sup- ported by educational grants from Alcon (Fort Worth, Texas), Carl Zeiss Meditec (Jena, Germany), and Johnson & John- son Vision (Santa Ana, California). will be treated, either surgically or with presbyopia-correcting glasses, whether bifocal, trifocal, or progres- sive. The risk/benefit of using these glasses is therefore the standard by which "doing no harm" with presbyopia correction surgery is to be judged. Just how safe are presbyopia-cor- recting glasses? Dr. Chang pointed out that edge-contrast sensitivity and depth perception are both reduced by glasses. This reduction makes presbyopic patients who use glasses up to 2.3 times more likely to fall. In fact, at least one out of three falls in the United States is attribut- able to these glasses. Consider that against the fact that falls account for more than 27,000 deaths in 2014. Is prescribing glasses rather than performing sur- gery really doing patients no harm? "We can help prevent falls with surgical correction of presbyopia," Dr. Chang said. Dr. Chang thinks presbyopia correcting surgery is the better, safer option, so much so that when his own mother required cataract surgery, he gave her presbyopia-cor- recting IOLs. Nicole Fram, MD, Los Angeles, in her discussion on "Exploring IOL Technologies for Presbyopic Pa- tients" at the symposium, supported Dr. Chang's perspective. While until recently options for presbyopia correction had been limited, characterized by significant trade-offs in terms of quality and so causing much disappointment to both patients and surgeons, today presbyopia-correcting IOLs are a saf- er, more efficacious technology. She said patients now have more treat- ment options and fewer trade-offs, and surgeons can be more confident in delivering the kind of vision they promise their patients. In order to ensure satisfaction, Dr. Fram said that surgeons must understand their patients' needs. Modern Cataract Practice: Optical Principles, Quality of Vision, and Addressing Clinical Challenges" on Monday afternoon. To answer the question, Dr. Chang went back to the underlying principle of any medical practice as laid down in the Hippocratic Oath, popularly summed up in the Latin phrase Primum non nocere—"First do no harm." What exactly does it mean to "do no harm" in the context of presbyopia correction? More precise- ly, by what standard do you judge that the risk/benefit of presbyopia correction surgery equates to "doing no harm"? Dr. Chang noted that in cata- ract surgery, presbyopia treatment is not optional. The condition T he common view of presby- opia correction, according to Daniel Chang, MD, Bakersfield, California, is that when patients pass the age of 40 and start to have trouble seeing at near distances, you can either prescribe them glasses and they'll be fine, or you can implant a "premium" IOL. The latter can make money, but it can also increase your chair time, risk of visual side effects, and potential for unhappy patients. But just how well does this view track with the reality of presbyopia correction? Dr. Chang discussed "The Real Risks and Benefits" of presbyopia correction in an EyeWorld CME Educational Symposium on "The Correction of Presbyopia in the Risk, benefit, and satisfaction with modern presbyopia correction Dr. Chang weighs the risk-benefit of presbyopia correction surgery against the use of glasses.

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