Cataract Surgery CE/CME ACCREDITED Watch Time: 28 mins

touchEXPERT OPINIONS Extending the range of vision with intraocular lenses: Implementing best practices for cataract surgery

Leading experts consider the latest intraocular lens technologies and discuss factors that influence intraocular lens selection in patients undergoing cataract surgery.

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Dr Elizabeth Yeu
Virginia Eye Consultants, Norfolk, VA, USA
Filling the gaps: Advances in intraocular lens design

Dr Elizabeth Yeu discusses how the expanding range of different intraocular lens designs can meet the needs and expectations of patients who require cataract surgery.

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In this interview Dr Yeu answers the following questions:

  • What are the key visual needs and expectations of patients after cataract surgery?
  • How can the currently available intraocular lenses be used to address the visual needs of patients?
  • What is the evidence for the effectiveness of trifocal and extended depth of focus lens technologies?
  • How could new and emerging intraocular lens technologies further address the visual needs of patients?
  • How can we select the right intraocular lens for patients to meet their postoperative goals?

Dr Yeu is a Cornea Specialist at Virginia Eye Consultants, Norfolk, VA, USA. Her specialties include dry eye and external diseases, and cataract surgery. She also serves as an Assistant Professor at Eastern Virginia Medical School and is the Medical Director of CVP Mid-Atlantic. 

Dr Elizabeth Yeu discloses: Consultancy for: Advanced Vision Group, Allergan, Aurion, Avellino, Bausch & Lomb/Valeant, BioTissue, BlephEx, Bruder, BVI, CorneaGen, Dompe, EyePoint Pharmaceuticals, Glaukos, Johnson & Johnson Vision, Kala Pharmaceuticals, LayerBio, LENSAR, Melt, Merck, Mynosys, Novartis, Ocular Science, Ocusoft, Omeros, Sight Sciences, STAAR, Sun, Surface, Tarsus, TearLab Corporation, Thea, Visus and Zeiss. Speaker’s bureau membership for: Alcon. Grants/research support from: Alcon, BioTissue, Ocular Science, Tarsus and TearLab Corporation. Stock/shareholder of: Advanced Vision Group, Aurion, Avellino, BlephEx, CorneaGen, Equinox, LayerBio, Mati, Melt, Mynosys, Ocular Science, Orasis, STAAR, Tarsus and Visus.

 
Dr Jennifer Loh
Loh Ophthalmology Associates, Miami, FL, USA
Intraocular lens selection: Key preoperative factors to consider

Dr Loh reviews the impact of ocular health and prior refractive surgery on the choice of intraocular lens, and discusses best practice for communicating with patients prior to cataract surgery.

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In this interview Dr Loh answers the following questions:

  • What patient-specific ocular characteristics need to be assessed for intraocular lens selection?
  • Does intraocular lens selection need special consideration in patients who have undergone previous refractive surgery?
  • What ocular pathological characteristics should be considered prior to intraocular lens selection?
  • How can we determine what the patient expects from surgery?
  • Prior to cataract surgery, how can we effectively communicate with patients regarding their choice of intraocular lens and refractive targets?

Dr Loh is Founder and Medical Director of Loh Ophthalmology Associates, Miami, FL, USA. She has a focus on cataract-refractive surgery and dry eye disease. She is also a clinical and surgical attending for the Larkin Hospital Ophthalmology Residency program.

Dr Jennifer Loh discloses: Advisory board or panel membership for: Aerie, Allergan, Bausch & Lomb, Imprimis, Johnson & Johnson Vision, Novartis, Ocular Therapeutics, Omeros, Orasis, Sight Sciences Sun and Zeiss. Grants/research support from: Sight Sciences. Speaker’s bureau membership for: Allergan, Kala, Sight Sciences and Sun. Stock/shareholder of:  Novabay.

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Overview & Learning Objectives
Overview

In this activity, Dr Elizabeth Yeu and Dr Jennifer Loh discuss the different types of intraocular lenses available, together with issues surrounding lens selection for patients who require cataract surgery, and best practice for helping patients to make informed decisions.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of ophthalmologists, including cataract and refractive surgeons, involved in the management of patients requiring cataract surgery.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Elizabeth Yeu discloses: Consultancy for: Advanced Vision Group, Allergan, Aurion, Avellino, Bausch & Lomb/Valeant, BioTissue, BlephEx, Bruder, BVI, CorneaGen, Dompe, EyePoint Pharmaceuticals, Glaukos, Johnson & Johnson Vision, Kala Pharmaceuticals, LayerBio, LENSAR, Melt, Merck, Mynosys, Novartis, Ocular Science, Ocusoft, Omeros, Sight Sciences, STAAR, Sun, Surface, Tarsus, TearLab Corporation, Thea, Visus and Zeiss. Speaker’s bureau membership for: Alcon. Grants/research support from: Alcon, BioTissue, Ocular Science, Tarsus and TearLab Corporation. Stock/shareholder of: Advanced Vision Group, Aurion, Avellino, BlephEx, CorneaGen, Equinox, LayerBio, Mati, Melt, Mynosys, Ocular Science, Orasis, STAAR, Tarsus and Visus.

Dr Jennifer Loh discloses: Advisory board or panel membership for: Aerie, Allergan, Bausch & Lomb, Imprimis, Johnson & Johnson Vision, Novartis, Ocular Therapeutics, Omeros, Orasis, Sight Sciences Sun and Zeiss. Grants/research support from: Sight Sciences. Speaker’s bureau membership for: Allergan, Kala, Sight Sciences and Sun. Stock/shareholder of:  Novabay.

Content Reviewer

Christopher Donovan, MD. has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Anne Nunn has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 7 April 2022. Date credits expire: 7 April 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Assess the effectiveness of advanced intraocular lenses to correct vision after cataract surgery
  • Discuss the key factors that impact intraocular lens selection in patients undergoing cataract surgery
  • Apply the most effective communication strategies for patients undergoing cataract surgery
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This Activity Is Funded By:

An independent medical education grant from Alcon Vision, LLC and Johnson & Johnson Surgical Vision, Inc. This activity is jointly provided by USF and touchIME.

The information provided by this CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CE to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 7 April 2022. Date credits expire: 7 April 2023.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
Which of the following is true regarding trifocal IOLs?

IOL, intraocular lens.
 Correct

Trifocal IOLs work by splitting light into three different foci to provide near, intermediate and distance vision. This division of light is also responsible for photic phenomena such as halos and glare, and loss of contrast sensitivity.1

Abbreviation

IOL, intraocular lens.

Reference

  1. Kondylis G, et al. Ann Eye Sci. 2019;4:5.
Question 2/5
Which of the following could indicate that a patient might have trouble accepting and accommodating post-surgery optical phenomena with IOLs?

IOL, intraocular lens.
 Correct

Personality traits have been shown to influence patient satisfaction with outcomes of IOL   implantation.1-3 Some patients may be less tolerant of optical compromises or less accepting of dysphotopsias, and this should be taken into consideration when selecting the type of IOL for an individual.1–3  

Abbreviation

IOL, intraocular lens.

References

  1. Yeu E, Cuozzo S. Ophthalmology. 2021;128:e132–41.
  2. Braga-Mele R, et al. J Cataract Refract Surg. 2014;40:313–22.
  3. Breyer DRH, et al. Asia-Pac J Ophthalmol. 2017;6:339–49.
Question 3/5
During an early consultation, your 65-year-old patient, who requires cataract surgery, asks which is the best type of IOL. He would like to continue playing golf without spectacles and he also enjoys reading. What is the most accurate response?

EDOF, extended depth of focus; IOL, intraocular lens.
 Correct

It is important for the surgeon to ask the patient about their lifestyle and activities to obtain a clear picture of his or her predominant visual needs.1,2 There are optical compromises with each type of lens:

  • EDOF IOLs provide better contrast sensitivity than bifocal IOLs, while providing good distance and intermediate vision3 
  • Trifocal IOLs provide good near, intermediate and distant vision, with better near vision than EDOF IOLs3 
  • Both trifocal and EDOF IOLs come with increased risk of photic phenomena compared with monofocal IOLs, although with less risk compared with bifocal IOLs.3
  • Photic phenomena tend to be a problem at night when looking at lit objects such as streetlights or car headlights.4

Golf is a sport that requires good distant vision (to see the hole in the distance and the ball as it travels), intermediate vision (to see the ball at one’s feet) and near vision (to view/write on the scorecard). The patient also requires good near vision for reading, but has not mentioned the need for good vision at night.

Abbreviations

EDOF, extended depth of focus; IOL, intraocular lens.   

References

  1. Breyer DRH, et al. Asia-Pac J Ophthalmol. 2017;6:339–49.
  2. Yeu E, Cuozzo S. Ophthalmology. 2021;128:e132–41.
  3. Kondylis G, et al. Ann Eye Sci. 2019;4:5.
  4. Ukai Y, et al. PLoS One. 2021;16:e0260406.
Question 4/5
For patients who require good night driving ability following cataract surgery and IOL implantation, what is likely to be an important factor in a decision between monofocal and multifocal IOLs?

IOL, intraocular lens.
 Correct

In a systematic database review, patients with multifocal IOLs were more likely to report halos and glare than patients fitted with monofocal IOLs.1 Night vision symptoms include glare (blurring of lights), halos (rings around lights) and starbursts (rays or streaks coming from lights).2 The pattern and amount of off-axis light energy or unfocused/defocused light correlates to the shape and intensity of the photopsia.2 

Abbreviation

IOL, intraocular lens.

References

  1. De Silva SR, et al. Cochrane Database Syst Rev. 2016;12:CD003169.
  2. Chang DH. Cataract Refract Surg Today. 2016. Available at: crst0816_cs_Chang.pdf (crstoday.com). Accessed 21 March 2022.
Question 5/5
What is best practice for decisions on IOL choice for patients who require cataract surgery?

IOL, intraocular lens.
 Correct

The IOL selection process for patients should involve both objective ocular assessment and evaluation of the their visual goals and personalities, which will assist surgeons in personalizing the IOL recommendation for optimal surgery outcomes.1 The patient has potential to be dissatisfied with the outcome of cataract surgery if he or she was not selected for temperament and counselled regarding possible optical aberrations, enhancements, and neuroadaptation.2 Therefore, consistent communication with the patient, making use of consultation time and providing additional informational resources, including opportunities for further questions, is important.3

Abbreviation

IOL, intraocular lens.

References

  1. Yeu E, Cuozzo S. Ophthalmology. 2021;128:e132–41.
  2. Braga-Mele R, et al. J Cataract Refract Surg. 2014;40:313–22.
  3. Loh J. Personal communication. 2022.
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