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An Ounce of Prevention

It’s an exciting time for cataract surgery, with many recent innovations in drug delivery devices and procedures to improve patient care and outcomes. In just the past several months, we’ve seen FDA approvals of a handful of eagerly awaited new drug formulations and devices, including cyclosporine ophthalmic solution 0.09% (Cequa, Sun Ophthalmics) for treatment of dry eye, a 0.4 mg dexamethasone ophthalmic insert (Dextenza, Ocular Therapeutix) for treatment of ocular pain and inflammation after ophthalmic surgery, and the AcrySof IQ PanOptix Trifocal IOL (Alcon).

These products are exciting new additions to our armamentarium, and each will play a role in cataract surgery, from preparing the ocular surface, to addressing patient compliance issues by improving drug delivery, to providing increased spectacle independence.

We’ve all heard Ben Franklin’s axiom, “An ounce of prevention is worth a pound of cure.” This saying resonates in many aspects of our professional lives, including in the care of refractive cataract surgery patients. We’ve seen the data on the prevalence of dry eye disease in patients prior to cataract surgery—up to 77%1—yet we’ve all had patients who state postoperatively that they never had dry eye until they had surgery. We know that ocular surface disease is a common reason for unpredictable refractive outcomes, patient dissatisfaction, and postoperative quality-of-life issues. It’s up to us to decide if we want to improve our patients’ outcomes and satisfaction by choosing to be proactive instead of reactive in treating their ocular surface disease. Oh, how we wish we had identified and treated it sooner for some of our dissatisfied patients.

In another example, think of the patient who received a toric IOL in an uneventful cataract procedure but remained with decreased BCVA postoperatively due to an unidentified lamellar macular hole. Should we be performing OCT before every elective cataract surgery procedure? Many practices are already doing this for premium IOLs, but should we take it a step further and provide it for all patients, including those receiving standard IOLs? By proactively capturing these images, we can identify subtle macular findings that can have an impact on IOL selection and patient satisfaction. Should OCT be the new norm for every cataract evaluation? Unfortunately, insurance doesn’t pay for “routine screening OCT,” so we face the question of how to implement this within our practices.

In this section of CollaborativeEYE, the focus is on cataract surgery complications that every optometrist should be able to recognize. As successful as cataract surgery is, it is real surgery with real risks. Although complications are rare, it is critical for anyone who provides postoperative care to identify early signs of complications, from the most common (ocular surface disease) to the least common but most devastating (endophthalmitis).

As you read through this section, consider not only postoperative complications, but also how you can optimize your patients’ outcomes by taking steps preoperatively. Thinking proactively about potential complications allows us to provide patients with outstanding visual results, increase their satisfaction, and improve their quality of life, no matter which lifestyle IOL they choose for their once-in-a-lifetime vision decision.

1. Trattler, WB, Majmudar PA, Donnenfeld, ED, McDonald MB, Stonecipher KG, Goldberg DF. The prospective health assessment of cataract patients’ ocular surface (PHACO) study: the effect of dry eye. Clin Ophthalmol. 2017:11:1423-1430.