Setting expectations is crucial to happy cataract refractive surgery patients

A tenet in co-managing cataract surgery is, “Satisfaction = Expectations - Results.” As optometrists, our job in cataract surgery is to ensure that a patient’s expectations are set appropriately and to monitor results via co-management.

Here, I review how to accomplish this with PanOptix (Alcon), a non-apodized diffractive trifocal IOL that has targeted focal points at distance, 60cm and 40cm.¹

SET EXPECTATIONS

For patients who desire gaining as much visual independence as possible, presbyopia-correcting IOLs will likely be their best fit.

The PanOptix IOL has an enlarged optic (center intermediate) in both spherical and toric platforms.¹ In an effort to increase contrast sensitivity and decrease pupil size dependency for reading, PanOptix employs the patented Enlighten optical technology to maximize incoming light utilization at 88%.¹

In recommending the trifocal IOL, I say: “In the early post-op period I do expect you to see some night-time glare, halos and starbursts; these almost always become non-bothersome over time (6 months), and time is our friend.” (PanOptix patients may experience night-time starbursts, glare and halos, which lessen over time with neural adaptation, similarly to other diffractive IOLs.²)

Also, I say: “Our goal is to give you independence from glasses for 95% of your visual activities at distance, intermediate and near. You may still need a thin pair of reading glasses in a dimly lit room.” That said, we do have some patients with a trifocal IOL who are able to read without the need for glasses.

MONITOR RESULTS

Post-operatively, the discussion with patients shifts to listening and identifying patient concerns, if they exist.

One concern that may arise includes visual gain. In patients who have expressed concern on post-op VA, I will show them their pre-op Snellen acuity without glasses as a comparison for visual gain. In patients with positive dysphotopsias, I may say: “The arc of light in your peripheral vision is most likely the edge of the implant. The implant is smaller in diameter than your natural lens was; this visual issue will go away over time.” This is inclusive of monofocal or presbyopia-correcting IOLs.

I also explain the timeline: “One month is really when the lens should be refractively stable, and we will plan our next steps if needed.”

Additionally, I revisit the common occurrences discussed in the pre-op discussion to assess the patient’s tolerance. For example, I like to show a patient who is struggling with near vision the positive effect of adding more light. Specifically, I turn on an overhead reading lamp and then discuss the need for good lighting for near tasks.

ACHIEVE SATISFIED PATIENTS

Patient expectations and visual needs are evolving as our cataract patient base becomes younger, more technology dependent and, most importantly, better informed on refractive outcomes. Satisfaction in my clinical ex-perience with PanOptix mirrors closely the clinical trial on the IOL, which shows over 90% of patients were “satisfied” or “very satisfied.” The addition of a trifocal IOL strengthens the refractive implant toolbox for both patients and practitioners. OM

REFERENCES

1. Alcon Data on File
2. Rosa, A., Miranda, A., Patricio, M., McAlinden, C., Silva, F., Castelo-Branco, M., & Murta, J. (2017, October). Functional magnetic resonance imaging to assess neuroadaptation to multifocal intraocular lenses. Journal of Cataract and Refractive Surgery, 43(10), 1287-1296.

DR. IBACH is a residency-trained optometrist at Vance Thompson Vision in Sioux Falls, SD. He specializes in anterior segment surgical care including cataracts, corneal diseases, glaucoma, and refractive surgeries. Dr. Ibach is a member of the American Optometric Association, among other professional affiliations. He is also a speaker for Alcon.