Cataract Surgery CME ACCREDITED Watch Time: 38 mins

touchPANEL DISCUSSION How do we improve the standard of care in cataract surgery?

Watch our touchPANEL DISCUSSION with internationally renowned specialists in ophthalmology discussing the latest advances in the management of cataract with intraocular (IOL) lens implantation and consider how the evolution of IOL technologies and changing patient expectations impact your own surgical decision making.

 

Prof. Elizabeth Yeu

Eastern Virginia Medical School, Norfolk, VA, USA

Chair

Panelists:
Prof. Antoine Brézin, Dr Ramón Ruiz Mesa
 
Introduction

Prof. Elizabeth Yeu chairs a discussion with Prof. Antoine Brézin and Dr. Ramón Ruiz Mesa on the available IOL technologies, patient selection for cataract surgery, and experience with multifocal IOLs for patients with cataracts.

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1/4 Next Chapter
What IOL technologies are available for patients with cataracts?

The expert panel discusses the latest presbyopia-correcting IOLs available for patients undergoing cataract surgery, with a focus on properties and characteristics influencing surgical choice.

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2/4 Next Chapter
How do we select the most appropriate IOL for the patient and meet patient expectations

The experts consider how to select the most appropriate IOL to meet the visual needs and expectations of individual patients undergoing cataract surgery.

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3/4 Next Chapter
What has been the experience with multifocal IOLs in patients with cataracts?

The expert panel review the data supporting the use of available multifocal IOLs and how this translates to the clinic.

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Overview & Learning Objectives
Overview

In this activity, experts in ophthalmology discuss important advances in the management of cataract with intraocular lens implantation.

This activity has been jointly provided by Oakstone and touchIME touchOPHTHALMOLOGY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

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Target Audience

This activity has been designed to meet the educational needs of Ophthalmic surgeons in the US, Canada and Rest of World

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Prof. Elizabeth Yeu discloses:  Advisory role/consultations/speaker bureau for Alcon, Allergan, Aurea Medical, Avedro, Avellino, Bausch & Lomb/Valeant, BioTissue, Beaver Visitec, BlephEx, Bruder, CorneaGen, Dompe, EyePoint Pharmaceuticals, iOptics, Glaukos, Guidepoint, J & J Vision, LENSAR, Kala Pharmaceuticals, Melt, Merck, Mynosys, Novartis, Ocular Science, Ocular Therapeutix, Ocusoft, Omeros, Oyster Point Pharmaceuticals, Science Based Health, Shire, Sight Sciences, Sun, Surface, TopCon, TearLab Corporation and Zeiss.  Research funding from
Beaver Visitec, Ocular Science and TopCon

Prof. AntoineBrézin  discloses:  Advisory role/consultant/speakers bureau for Alcon.  Other financial or material support to Hoya

Dr Ramón Ruiz Mesa discloses:  Consultancy role for Alcon, Dorc, Hoya, iOptics, J&J, Ophtec, Physiol, Sifi and Ziemer

Content Reviewer

Walter Murray Yarbrough, MD, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

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 the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide contining medical education for physicians.

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 Categoty 1 Credit into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™️. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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

Date of original release: March 20, 2020. Date credits expire: March 20, 2021.

Learning Objectives

After watching this touchPANEL DISCUSSION, you should be able to:

  • Discuss the current intraocular lens (IOL) technologies available for cataract patients
  • Recognize the need to carefully select patients for IOL and understand the need to manage patient expectations
  • Evaluate the existing data supporting the different IOL technologies in order to make an informed decision for their cataract patients
Faculty & Disclosures
Prof. Elizabeth Yeu

Eastern Virginia Medical School, Norfolk, VA, USA

Elizabeth Yeu is a partner at Virginia Eye Consultants and supports residency training in Ophthalmology as an Assistant Professor at the Eastern Virginia Medical School. She is the Medical Director of the Virginia Surgery Center and sits on the Board of Directors for the Virginia Eye Foundation. Prof. Yeu has authored numerous articles and has lectured both nationally and internationally on refractive cataract surgery, anterior segment reconstruction, ocular surface disease management, and surgical management of astigmatism.

Disclosures: Advisory role/consultations/speaker bureau for Alcon, Allergan, Aurea Medical, Avedro, Avellino, Bausch & Lomb/Valeant, BioTissue, Beaver Visitec, BlephEx, Bruder, CorneaGen, Dompe, EyePoint Pharmaceuticals, iOptics, Glaukos, Guidepoint, J & J Vision, LENSAR, Kala Pharmaceuticals, Melt, Merck, Mynosys, Novartis, Ocular Science, Ocular Therapeutix, Ocusoft, Omeros, Oyster Point Pharmaceuticals, Science Based Health, Shire, Sight Sciences, Sun, Surface, TopCon, TearLab Corporation and Zeiss.  Research funding from
Beaver Visitec, Ocular Science and TopCon

Prof. Antoine Brézin

Paris Descartes University School of Medicine, Paris, France

Antoine Brézin is Professor of Ophthalmology at the Paris Descartes University School of Medicine, Paris, France. He chairs the Department of Ophthalmology at Cochin Hospital, Paris, where more than 10,000 procedures are performed each year, and which ranks as the top French hospital for cataract surgery. He has participated in many international projects in the fields of cataract surgery and intraocular inflammation, and has published more than 150 articles in international journals.

Disclosures: Advisory role/consultant/speakers bureau for Alcon.  Other financial or material support to Hoya

Dr Ramón Ruiz Mesa

Eye Clinic OFTALVIST, Andalucía, Spain

Ramón Ruiz Mesa is the Medical Director of the Eye Clinic OFTALVIST in Andalucía, Spain where he performs more than 1,500 surgical procedures each year. Dr. Ruiz Mesa is an active researcher and has been involved in several national and international multicenter studies. He has published more than 15 scientific articles and five books on cataract surgery and refractive surgery.

Disclosures: Consultancy role for Alcon, Dorc, Hoya, iOptics, J&J, Ophtec, Physiol, Sifi and Ziemer

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

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Question 1/4
When comparing monofocal and multifocal IOLs, which one is least likely to be associated with spectacle-dependence post surgery?
Correct

A Cochrane review has revealed that patients receiving multifocal IOLs were less likely to be spectacle-dependent than those with monofocal IOLs, with better near vision.

IOL, intraocular lens

References
de Silva SR, Evans JR, Kirthi V, et al. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2016, Issue 12. Art. No.: CD003169. DOI: 10.1002/14651858.CD003169.pub4.

Question 2/4
What is a major driver for choice of IOL from the patient’s perspective prior to cataract surgery and is an indicator of patient satisfaction post-surgery?
Correct

A number of factors have been correlated with overall patient satisfaction of IOL procedures (irrespective of personality type), and include low astigmatism, good visual function, low spectacle dependence, and fewer halos/less glare.1 These will be the major drivers for choice of IOL from the patient perspective. However, it is also important to ensure that patients have realistic expectations before surgery.2

IOL, intraocular lens

References
1. Mester U et al. J Refract Surg 2014;30:674–8.
2. Alió JL, et al. Survey of Ophthalmol 2017;62:611–34

Question 3/4
When discussing the risk of halos associated with multifocal IOLs with your patients, which of the following statements would you counsel preoperatively to manage their expectations?
Correct

Halos have been observed in around 1 in 4 patients at the 1-month postop examination; however, this percentage drops to 1 in 8 after 6 months.1 In terms of severity, only 7.5% report severe problems after 3 months.1 Due to neural adaptation, these would be expected to decreased over time.2 Trifocal provide better intermediate visual acuity and similar or better near and distance visual acuity without any major deterioration in visual quality versus bifocal IOLs.3

IOL, intraocular lens.

References
1. Piovella M et al. Eye 2019;33:144–53.
2. Law EM et al. Eur J Ophthalmol 2014;24:501–8.
3. Yoon CH, et al. J Korean Med Sci 2018;33:e275.

Question 4/4
A 63-year-old lady presents to your clinic for cataract surgery. She indicates a need for good functioning near visual acuity as well as the ability to be able to work across her desktop computer, laptop, and her smartphone. Based on current evidence, which of the following IOLs would you recommend for her?
Correct

Compared to bifocals, trifocal IOLs have better intermediate VA.1 EDOF IOLs versus monofocal IOLs offer better intermediate and near VA, but are associated with increased risk of contrast reduction and more frequent halos.2 EDOF IOLs versus trifocal IOLs may offer better contrast sensitivity, but at the expense of near vision.2 EDOF IOLs and trifocal IOLs are comparable for halo incidence and spectacle independence.2

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

References
1.Jin S, et al. BMC Ophthalmol 2019;19:78.
2. Liu J, et al. BMC Ophthalmol 2019;19:198.

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