Phacoemulsification in cataract surgery: Evolving options to optimize refractive outcomes
In this interview, Dr Ahmed answers the following questions:
- Why is balancing irrigation, aspiration and vacuum important for maintaining IOP and anterior chamber stability during phacoemulsification?
- How do differences between peristaltic and venturi pump systems affect your choice of settings for different cataract densities or surgical scenarios?
- What are the key considerations for personalizing the choice between continuous, pulse and burst ultrasound energy delivery for each patient?
- What are the most common challenges you encounter when optimizing phaco settings for complex cataracts, and how do you overcome them?
Dr Ike K Ahmed is the John R & Hazel M Robertson presidential endowed chair and professor at the Department of Ophthalmology Visual Sciences at the University of Utah, USA. He is also the director of the Alan S Crandall Center for Glaucoma Innovation at the John A Moran Eye Center, and the director of the Glaucoma & Advanced Anterior Segment Surgery (GAASS) Fellowship at the University of Toronto, Canada, and chief innovation officer at Prism Eye Institute, Canada. Dr Ahmed is a surgeon scientist who has been an international leader in novel approaches in glaucoma, complex cataract and lens implant surgery, practising and conducting research in both Canada and the USA. He is recognized as being one of the most experienced complex eye surgeons globally, and patients are referred to him from around the world. His leadership and pioneering work in innovative glaucoma surgery includes developing and coining the terms ‘interventional glaucoma (IG)’, ‘microinvasive glaucoma surgery (MIGS)’ and ‘microinvasive bleb surgery (MIBS)’. Dr Ahmed’s lab at the Crandall Center is focused on glaucoma surgical devices and laser therapies and Dr Ahmed has published widely. Dr Ahmed received the Binkhorst Medal, which is awarded to the world’s most prominent ophthalmologists whose careers have made significant impact on the science and practice of ophthalmology, and he was recognized as #1 Most Influential Ophthalmologist in the World by The Ophthalmologist. Recently, he was bestowed with the King Charles III Coronation Medal for his extraordinary contributions to the field.
Dr Ike K Ahmed discloses: Consultancy fees from AbbVie, Ace Vision Group Inc, Alcon, Aliph Medical, Apellis Pharmaceuticals, Aquea Health Inc, ArcScan, Avellino Lab USA Inc, Avisi Technologies Inc, Balance Ophthalmics, Bausch and Lomb, Beaver Visitec, Belkin Vision, Bionode, Carl Zeiss, Centricity Vision Inc, Ciliatech, CorNeat Vision, Custom Surgical, Dragonfleye Therapeutics Corp, Elios Vision, ElutiMed, Eye to Eye Telehealth Inc, eyeFlow Inc, EyeMed, EyeQ Technologies, EyeX Solutions, Exhaura Limited, Glaukos, Gore, Hexiris Pharma, Iantrek, iCare, Implandata, InjectSense, Iridex, iStar, Johnson & Johnson Vision, LayerBio, LIQID Medical, Long Bridge Medical Inc, Medicontur, MST Surgical, Myra Vision, New World Medical, Nova Eye, Noxelis, Ocular Instruments, Ocular Therapeutix, Oculus Surgical, OcuSciences, Omega Ophthalmics, Ophthalmic Therapeutic Innovations LLC, Peripherex, PolyActiva, PulseMedica, Qlaris Bio, Radiance Therapeutics Inc, Radius XR, Regeneron Pharmaceuticals Inc, Rheon Medical SA, Ripple Therapeutics, Sanoculis, Santen, SeonixBio, Shifamed LLC, Singapore Biodesign, Sight Sciences, Smartlens Inc, Stroma, Tavo BioTherapeutics Inc, TFS Health Science, Thea Pharma, ViaLase, Visci Ltd, Visus Therapeutics, Vizzario and Zilia Inc. Research grant/support from AbbVie, Alcon, Bionode LLC, CorNeat Vision, Elios Vision, Glaukos, Gore Medical, iCare, iStar, Johnson & Johnson Vision, Myra Vision, New World Medical and Santen.
In this interview, Dr Chang answers the following questions:
- What are the main clinical differences between cohesive and dispersive OVDs, and how should they be selected during routine cataract surgery?
- Are there specific complex scenarios where your OVD selection strategy may vary, leading you to prefer one form over the other?
- How can OVD selection affect the outcomes of cataract surgery when intraoperative complications arise?
Dr David F Chang, MD, is a Summa Cum Laude graduate of Harvard College and Harvard Medical School. He completed his ophthalmology residency at the University of California, San Francisco where he achieved the rank of clinical professor in 1999. Dr Chang is past president of the American Society of Cataract and Refractive Surgery (ASCRS) and he served on their executive board for 15 years. He is a past chair of the American Academy of Ophthalmology (AAO) Cataract Preferred Practice Pattern Panel and the AAO Annual Meeting Program Committee. Dr Chang previously served as chief medical editor of EyeWorld and Cataract and Refractive Surgery Today. He is past chair of the ASCRS Foundation and received the 2019 AAO Humanitarian Service Award and the 2020 Aravind Venkataswamy Award. Dr Chang is co-founder and the advisory board chair of EyeSustain, a global consortium of more than 50 eye societies advancing sustainability in ophthalmology. Dr Chang has received the highest honours for an anterior segment surgeon from the following international organizations: AAO (Kelman Lecture), ASCRS (Binkhorst Medal and Kelman Innovator Award), European Society Of Cataract & Refractive Surgeons (Ridley Medal), Asia-Pacific Association of Cataract and Refractive Surgeons (Lim Medal), United Kingdom & Ireland Society of Cataract & Refractive Surgeons (Rayner Medal), Royal Australian and New Zealand College of Ophthalmologists (Gregg Medal), Asia-Pacific Academy of Ophthalmology (Jose Rizal International Medal), The Middle East African Council of Ophthalmology (El-Maghraby International Award), and the International Council of Ophthalmology (Tadeusz Krwawicz Gold Medal). Including these, he has delivered more than 50 named lectures. In a poll of American ophthalmologists, Dr Chang was voted #3 in Newsweek’s 2023 list of the top 100 ophthalmologists in the United States. He was ranked #2 in the 2024 ‘Power List’ of the 100 most influential ophthalmologists, as selected by The Ophthalmologist.
Dr David F Chang discloses: Consultancy fees from Alcon, Carl Zeiss, Centricity, EyeMed, Forsight Robotics, ForSight Vision 6, Iantrek, Jellisee, Johnson & Johnson Vision, Longbridge Medical, Orasis, Perfect Lens, RxSight, Surface and Sydnexis. Stock/shareholder (self-managed) Centricity, Forsight Robotics, ForSight Vision 6, Iantrek, Jellisee, Longbridge Medical, Orasis, Perfect Lens, RxSight, Surface and Sydnexis.
In this interview, Dr Loh answers the following questions:
- How do newer active-fluidics systems differ from traditional gravity-based systems in maintaining near-physiologic IOP during cataract surgery?
- Can you discuss recent advances in ultrasound energy delivery and their role in ocular tissue protection during cataract surgery?
- What are the advantages of microincision cataract surgery and prefragmentation in reducing phaco energy and enhancing surgical outcomes, particularly for dense cataracts?
- Has FLACS changed your approach to complex cases or premium IOL implantation, and what are its main benefits and limitations compared with conventional phacoemulsification?
- What newly available and emerging next-generation phaco systems and technologies should surgeons be aware of?
Dr Jennifer Loh, MD, is a board-certified ophthalmologist practising in Miami, Florida, with a focus on cataract and refractive surgery and dry eye disease. Dr Loh is founder and medical director of her practice, Loh Ophthalmology Associates, which she started in 2016. Dr Loh also spends her time as a clinical and surgical attending for the Larkin Hospital Ophthalmology Residency programme. She is a graduate of Indiana University School of Medicine, where she completed both medical school and ophthalmology residency. On a personal note, Dr Loh enjoys skiing and travelling the world with her husband and 6-year-old son.
Dr Jennifer Loh discloses: Advisory board/panel fees from AbbVie, Alcon, Bausch and Lomb, Beaver Visitec International, Biotissue, Bruder Healthcare, Dompe, Eyenovia, Horizon Therapeutics, Johnson & Johnson Vision, Nordic Pharma, Novabay, Ocular Science, Orasis, Science Based Health, Sight Sciences, Sun Ophthalmics, Tarsus, Thea, Visus/Tenpoint Therapeutics and Zeiss. Consultancy fees from AbbVie, Alcon, Bausch and Lomb, Beaver Visitec International, Biotissue, Bruder Healthcare, C. Light Technologies, Dompe, Eyenovia, Horizon Therapeutics, Johnson & Johnson Vision, LensAR, Nordic Pharma, Ocular Science, Science Based Health, Sight Sciences, Sun Ophthalmics, Tarsus, Thea, Visus/Tenpoint Therapeutics and Zeiss. Grants/research support from Sight Sciences. Speakers’ bureau fees from AbbVie, Alcon, Orasis, Sight Sciences and Sun Ophthalmics.
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