Cataract Surgery, Refractive Surgery CME ACCREDITED Watch Time: 25 mins

touchEXPERT OPINIONS How are novel IOL technologies increasing the range of vision after cataract surgery?

Watch leading expert Dr John Hovanesian discuss advances in intraocular lens (IOL) technologies and how novel IOLs help meet the needs and preferences of individual patients after cataract surgery.

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Expert Interviews
Driving forward innovative IOL technologies: How to meet high patient expectations after cataract surgery?

Dr John Hovanesian discusses how novel intraocular lens (IOL) technologies are designed to meet the increasing expectations of patients undergoing cataract surgery.

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Interview Questions

In this interview, Dr Hovanesian answers the following questions:

  • What are the key visual needs and expectations of patients after cataract surgery?
  • How do we assess patient needs and preferences to help select the best IOL for each patient?
  • How do the designs of available IOLs address near, intermediate and far visual needs of patients?
  • Do IOLs with improved range of vision tend to be associated with fewer/less severe visual disturbances?
  • What new and emerging IOL technologies may further address patient needs?
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Expert Interviews
Navigating novel IOL technologies: How can we differentiate between available IOL models?

Dr John Hovanesian looks at the properties of different intraocular lens (IOL) models and how certain design features may influence IOL performance.

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Interview Questions

In this interview, Dr Hovanesian answers the following questions:

  • How do differences between refractive and/or diffractive technologies influence multifocal IOL choice?
  • What other design features are important to consider when assessing IOL performance for individual patients?
  • How does the biomaterial influence IOL performance?
  • How does awareness of different characteristics of available IOLs assist surgeons in the choice of the most appropriate lens?
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Expert Interviews
The way forward in cataract surgery: What is the experience with specialised IOLs?

Dr John Hovanesian reviews the evidence base for intraocular lenses (IOLs), before considering the impact of patient–reported outcomes on lens selection. He then goes on to look at how clinicians may match patients with the right IOL technology.

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Interview Questions

In this interview, Dr Hovanesian answers the following questions:

  • What is the evidence for the effectiveness of available IOL technologies?
  • What do patient–reported outcomes tell us about multifocal IOLs?
  • What is the added value of patient-reported outcomes in assessing IOL outcomes for individual patients?
  • How can we best pair patients with the right IOL technology?
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Overview & Learning Objectives
Overview

In this activity, Dr John Hovanesian, an expert in ophthalmology, discusses the latest developments in intraocular lens (IOL) technologies designed to meet patients’ visual needs for near, intermediate and distant vision, and considers how to best select an IOL model for individual patients.

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

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

Dr John Hovanesian discloses Consultant fees from 1-800-Doctors, Inc., AcuFocus, Inc., Aerie Pharmaceuticals, Alcon, Allegro Ophthalmics LLC, Allergan, Inc., Abbott Medical Optics, BlephEx™, Eyedetec Medical, Inc., Glaukos Corp, Guardion Health Sciences, IOP Ophthalmics/Katena Products, Inc., Ivantis Inc., Kala Pharmaceuticals, Novartis, Ocular Therapeutix, Omeros, Sarentis Ophthalmics, Sensimed AG, Shire, TearLab Corporation, Tear Film Innovations Inc., Valeant Pharmaceuticals, Veracity, Vindico Medical Education; Medical Advisory Board fees from 1-800-Doctors, Inc., Aerie Pharmaceuticals, Abbott Medical Optics, BlephEx™, Cord LLC, Eyedetec Medical, Inc., Glaukos Corp, Guardion Health Sciences, InnoEye Technologies Pvt. Ltd., IOP Ophthalmics/Katena Products, Inc., Ivantis Inc., Kala Pharmaceuticals, MDbackline, Ocular Therapeutix, Omeros, Shire, Sight Sciences, TearLab Corporation, Tear Film Innovations Inc., Valeant Pharmaceuticals, Veracity; Research fees from AcuFocus, Inc., Aerie Pharmaceuticals, Alcon, Allergan, Abbott Medical Optics, Cloudbreak Therapeutics, Cord LLC, Eyedetec Medical Inc., Glaukos Corp, InnoEye Technologies Pvt. Ltd., IOP Ophthalmics/Katena Products, Inc., Novartis, Ocular Therapeutix, Omeros, Shire, Tear Film Innovations Inc., Valeant Pharmaceuticals; Equity interest from Alcon, Alicia Surgery Center, Allegro Ophthalmics LLC, Allergan, BlephEx™, Eyedetec Medical, Inc., Glaukos Corp, Guardion Health Sciences, Harvard Eye Associates, Harvard Hearing, InnoEye Technologies Pvt. Ltd., MDbackline, Novartis, Ocular Therapeutix, RxSight, Inc., Sarentis Ophthalmics, Sight Sciences Inc., Tear Film Innovations Inc.; Royalties from sales from SLACK Books, TLC Group Laser Clinic.

Content Reviewer

Walter Murray Yarbrough, MD, FACP 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 continuing 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 Category 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 Credits™. 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: 21 January 2021. Date credits expire: 21 January 2022.

Learning Objectives

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

  • Understand the rationale for novel intraocular lens (IOL) technologies designed to meet patients’ visual needs (near, intermediate and distant)
  • Discuss the differentiating features of novel IOL technologies and implications for patient satisfaction
  • Review the available evidence for novel IOL technologies and how this translates to IOL selection in clinical practice
About Dr John Hovanesian
Dr John Hovanesian

UCLA Jules Stein Eye Institute, Los Angeles, CA, USA

John Hovanesian, MD, is an internationally recognized leader and innovator in cataract, corneal, and laser eye surgery. He is a board-certified ophthalmologist and faculty member at the UCLA Stein Eye Institute, Los Angeles, CA, USA. read more

He has been invited to lecture to surgeons on six continents, authored dozens of peer-reviewed articles and produced many frequently referenced surgical teaching videos. He is the cataract surgery section editor for the world’s most widely read eye care trade journal, Ocular Surgery News US Edition, and serves on several other editorial boards.

Dr Hovanesian is a member of the prestigious International Intraocular Implant Club that includes the world’s 300 most respected cataract surgeons. He is a recipient of the American Academy of Ophthalmology’s Senior Achievement Award.

Dr Hovanesian has made dozens of volunteer surgical trips to developing countries, including Armenia, Mexico, Honduras, El Salvador and Fiji, and is a founding board member of the Armenian Eye Care Project. He has spent over 20 years volunteering as a board member, board chairman, and as an adult leader for the Boy Scouts of America, which has presented him with numerous service awards, including naming him a Distinguished Eagle Scout for internationally recognized contributions to his professional field.

Dr John Hovanesian discloses Consultant fees from 1-800-Doctors, Inc., AcuFocus, Inc., Aerie Pharmaceuticals, Alcon, Allegro Ophthalmics LLC, Allergan, Inc., Abbott Medical Optics, BlephEx™, Eyedetec Medical, Inc., Glaukos Corp, Guardion Health Sciences, IOP Ophthalmics/Katena Products, Inc., Ivantis Inc., Kala Pharmaceuticals, Novartis, Ocular Therapeutix, Omeros, Sarentis Ophthalmics, Sensimed AG, Shire, TearLab Corporation, Tear Film Innovations Inc., Valeant Pharmaceuticals, Veracity, Vindico Medical Education; Medical Advisory Board fees from 1-800-Doctors, Inc., Aerie Pharmaceuticals, Abbott Medical Optics, BlephEx™, Cord LLC, Eyedetec Medical, Inc., Glaukos Corp, Guardion Health Sciences, InnoEye Technologies Pvt. Ltd., IOP Ophthalmics/Katena Products, Inc., Ivantis Inc., Kala Pharmaceuticals, MDbackline, Ocular Therapeutix, Omeros, Shire, Sight Sciences, TearLab Corporation, Tear Film Innovations Inc., Valeant Pharmaceuticals, Veracity; Research fees from AcuFocus, Inc., Aerie Pharmaceuticals, Alcon, Allergan, Abbott Medical Optics, Cloudbreak Therapeutics, Cord LLC, Eyedetec Medical Inc., Glaukos Corp, InnoEye Technologies Pvt. Ltd., IOP Ophthalmics/Katena Products, Inc., Novartis, Ocular Therapeutix, Omeros, Shire, Tear Film Innovations Inc., Valeant Pharmaceuticals; Equity interest from Alcon, Alicia Surgery Center, Allegro Ophthalmics LLC, Allergan, BlephEx™, Eyedetec Medical, Inc., Glaukos Corp, Guardion Health Sciences, Harvard Eye Associates, Harvard Hearing, InnoEye Technologies Pvt. Ltd., MDbackline, Novartis, Ocular Therapeutix, RxSight, Inc., Sarentis Ophthalmics, Sight Sciences Inc., Tear Film Innovations Inc.; Royalties from sales from SLACK Books, TLC Group Laser Clinic.

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

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Question 1/4
Which of the following statements best describes current patient expectations after cataract surgery?
Correct

Advances in manufacturing and surgical techniques mean an increasing variety of novel IOLs are available to the cataract surgeon. Alongside these advances, there has been an upswing in patient expectations after cataract surgery.1,2 Patient expectations include:1,2

  • Spectacle independence
  • Good uncorrected distance visual acuity
  • Good intermediate and near sight
  • No complications/unsatisfactory results

Abbreviations
IOL, intraocular lens.

References
1. Bianchi GR. Med Hypothesis Discov Innov Ophthalmol. 2020;9:38–46.
2. Salerno C, et al. Taiwan J Ophthalmol. 2017;7:179–84.

Question 2/4
When discussing cataract surgery with your patient, you learn that good intermediate vision and minimal undesirable optical phenomena, such as glare, halos and loss of contrast sensitivity, are important patient preferences. Which type of IOL would you suggest for this patient?
Correct

Traditional trifocals provide focus at near, intermediate and far distances, however, the division of light when passing through a trifocal IOL results in glare, halos, and loss of contrast sensitivity. EDOFs have an extended depth of focus zone and aim to provide improved visual acuity at intermediate distances and provide a continuous range of vision. EDOFs have less off-axis light and are associated with fewer/less severe visual disturbances and yield better contrast sensitivity compared with traditional multifocal lenses.

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

Reference
Werner L. Ophthalmology. 2020;S0161-6420(20)30626-6.

Question 3/4
During a pre-operative discussion with your patient about which IOL could best satisfy their visual needs, what recent data can you share about the possible rate of spectacle independence achievable with a premium trifocal IOL?
Correct

In a study of patient satisfaction, visual disturbances, and uncorrected visual performance, patients completed a PRO questionnaire at least 1 month after uncomplicated bilateral implantation with the Panoptix trifocal IOL (n=59). Spectacle independence was measured as the percentage of patients who do not require glasses for each of the common activities queried like driving, reading, computer work, watching TV, and sports/hobbies.

  • For all the activities combined, 83% of patients reported that they “never need glasses”
  • Spectacle independence was greater with the trifocal lens compared with all previously studied lens combinations (p<0.0001)

Abbreviations
PROs, patient-reported outcomes; IOL, intraocular lens.

Reference
Content provided courtesy of John A. Hovanesian MD, Clinical Faculty, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA. Data presented at ASCRS 2020. Abstract available at: https://ascrs.org/clinical-education/presbyopia/2020-pod-sps-108-60552-the-panoptix-trifocal-iol-a-study-of-patient-satisfaction-visual (accessed January 2021).

Question 4/4
Your patient desires less spectacle dependence. When you consider other lifestyle factors and their ocular heath, in which circumstances below would you consider using a premium trifocal IOL for this patient?
Correct

Patient selection is the key factor in obtaining the best visual outcomes after cataract surgery and IOL implantation, and requires consideration of the patients’ ocular health and lifestyle.1

  • Patients with comorbidities such as dry eye, mild maculopathy, and corneal aberrations as a result of previous refractive surgery or that occur natively, may not be candidates for a multifocal lens.2
  • Undesirable optical phenomena such as glare, halos, and loss of contrast sensitivity are associated with traditional multifocal lenses.3

Abbreviations
IOL, intraocular lens.

References
1. Eisenberg JS. 2017. Available at: https://www.reviewofophthalmology.com/CMSDocuments/2017/1/rp0117i.pdf
2. Hovanesian JA. Clin Ophthal. 2018;12:2297–2304.
3. L. Ophthalmology. 2020;S0161-6420(20)30626-6.

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