by Matt Young
Rapid innovation in medical devices and medications has resulted in a wider and better range of treatment options in cataract surgery. This allows cataract surgeons to plan and design treatments accordingly to help meet patient expectations, as well as improve vision and quality of life.
During the Santen Lunch Symposium on the first day of the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2019) annual meeting in Kyoto, Japan, three experts shared their tips to enhance patient satisfaction following cataract surgery, in a presentation titled The Most Natural Choice in Cataract Surgery.
Novel IOLs
Dr. Hiroyuki Arai from the Queen’s Eye Clinic, Japan, discussed selecting appropriate intraocular lenses (IOLs) for individual patients in a paper called Optimize Outcomes with the Choice of IOLs and Innovations.
IOL options have expanded with the emergence of multifocal and extended depth of focus (EDoF) lens. In this vein, Dr. Arai introduced a new IOL – the LENTIS Comfort – which was launched in April last year. The IOL has been approved in Japan and is covered by the Japanese national health insurance program. Dr. Arai emphasized that this low-add segmental IOL is designed to minimize light loss and has almost no glare and halos.
Postoperative Dry Eye Management
Dry eye disease (DED) after cataract surgery has become a critical concern, and various treatments have been developed to counter this condition. “Most cataract surgery patients have prior ocular surface disease (OSD),” said Adjunct Associate Professor Lim Li from the Singapore National Eye Centre (SNEC).
Clinical signs of dry eye are commonly found in cataract patients before surgery. “However, the majority of patients were asymptomatic or minimally symptomatic,” said Prof. Lim about a recent study. Seventy-seven percent of eyes had abnormal corneal staining and more than 60% of patients had an abnormal tear film break-up time (TBUT). Additionally, a blurred vision was more likely than burning or foreign body sensation.
So, why is it important to manage the ocular surface?
Preoperative biometry and topography could be affected, as well as postoperative outcomes, like visual and refractive results. According to Prof. Lim, studies have shown that hyperosmolarity of the tear film is associated with significantly more variability in average keratometry readings and anterior corneal astigmatism. This may result in significant differences in IOL power calculations.
“Corneal staining is the single most critical sign of OSD that should be normalized before cataract and refractive surgery,” said Prof. Lim.
Artificial tear preparations such as Hialid (Santen Pharmaceuticals, Tokyo, Japan), which contain various polymers like cellulose derivatives and hyaluronic acid, is the first-line treatment for dry eye symptoms after cataract and refractive surgery due to their effectiveness in alleviating symptoms of dry eye after cataract surgery.
Therapeutic contact lenses may be beneficial for severe OSD including corneal ulcers, persistent epithelial defects, corneal perforation, and chemical burns. Bandage lens may be used in the preoperative setting to allow epithelial healing of punctate keratitis before preoperative biometry measurements.
“Visually significant (VS) OSD leads to reduced visual quality and potential errors in preoperative measurements,” cautioned Prof. Lim. In short, according to Prof. Lim, it is important to identify VS OSD patients, defer preoperative measurements until fully treated and resolved (as they can be affected), postpone surgery, and treat patients before surgery to achieve an optimal outcome.
“A study found that the use of an aspirating speculum aggravated dry eye parameters during the early postoperative period after cataract surgery,” said Professor Jong Suk Song from the Korea University College of Medicine in South Korea.
Cataract surgery can also worsen ocular surface parameters and aggravate dry eye disease. Therefore, he advised physicians to aggressively treat cataract patients with existing dry eye disease.
In addition, increased incision extent, operation time, irrigation and microscopic-light exposure time decreased the TBUT and goblet cell density. And the use of topical eye drops after cataract surgery can worsen the goblet cell density. Conjunctival goblet cell loss in dry eye is associated with ocular surface inflammation.
According to Prof. Jong, studies have revealed that preservative-free diquafosol showed better efficacy in treating DED after cataract surgery than preservative-containing diquafosol or preservative-free hyaluronate. “Therefore, preservative-free diquafosol may serve as a reliable option for the management of patients with pre-existing DED after phacoemulsification,” he concluded.
These practical tips from renowned surgeons should help to manage patients’ expectations and improve satisfaction – which is valuable advice for any cataract surgery practice.
Editor’s Note: This article was first published in CAKE Today, CAKE Magazine’s electronic daily congress news, Media MICE’s daily at the Asia-Pacific Association of Cataract and Refractive Surgeons annual meeting (APACRS 2019) held in Kyoto, Japan, on October 3-5, 2019.
