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More and more patients are electing to choose an advanced intraocular lens (IOL) implant to correct their vision after cataract surgery. We educate all patients on IOL options including monofocal IOL, toric monofocal implants for astigmatism correction and presbyopia-correcting implants that address provide favorable distance, intermediate, and near vision. We find that when a patient chooses a traditional monofocal implant, they are at peace, because they were educated on all the options and feel that they made an informed decision.
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The cataract evaluation is a comprehensive ocular evaluation in addition to the determination of the cataract’s impact on vision. The pre-operative evalution includes an anterior and dilated posterior segment slit lamp examination, dry eye testing, corneal topography and advanced corneal imaging to quantify irregularities present in the cornea, measurements to determine IOL power, posterior segment photography/OCT, an extensive discussion on cataract surgery and IOL options, a discussion of risks/benefits with informed consent, patient education and counseling on costs and instructions. The comprehensive approach aims to determine candidacy for IOL options and guide the discussion with the patient. It is our job as doctors to identify which patients are good candidates for refractive cataract surgery and which patients will perform better with a monofocal IOL. The discussion regarding IOL options also includes an extensive discussion about expectations after surgery, particularly if the patient elects for an advanced technology IOL
Expectations of cataract patients have evolved owing to advances in vision-correcting technology. We find that after a thorough discussion of implant options, many implant patients choose the traditional, monofocal implant. These lenses provide an excellent quality of vision yet patients understand the need for spectacles with this type of implant. When patients select a monofocal implant they are appreciative of the discussion about the range of lens implants available to them that could have provided more freedom from corrective lenses after surgery.
The patients that choose the advanced implants have a desire for reduced spectacle dependence, similar to a younger patient presenting for LASIK. They want to be able to experience life without glasses or contacts. They are fine having a pair of glasses for certain activities, but they have a great desire to function throughout the day without optical devices. We offer the full array of advanced implants to meet the needs or expectations of patients and maximize the chance of delivering an excellent outcome.
Educating the patient on the risks of cataract surgery through an adequate informed consent procedure is paramount. Informed consent can be accomplished through written documents or video tapes and can include written tests on the material. An informed consent document contains descriptions of the procedure, alternative treatments and options, and a thorough list of potential risks.
Risks that should be included in a cataract informed consent document should include blindness, infection, cystoid macular edema, retinal detachment or hemorrhage, overcorrection, under correction, corneal scarring, irregular astigmatism, anisometropia, reduced BCVA, difficulty wearing contact lenses postoperatively, the potential need for permanent glasses correction, and that it is impossible to list every complication that may occur as a result of surgery.
Patients are seen at 1 day, 1 week, 1 month, 3 month,s and 6 months after surgery*
*Patients implanted with the Light Adjustable Lens will follow a postoperative schedule tailored to the patient
At the one-week post-op exam, we like to see the uncorrected and best-corrected vision with manifest refraction, slit lamp exam, and IOP. We also remind patients at this visit that refractive cataract surgery is a process and may require additional steps (eg, laser refractive enhancement) to maximize their visual outcome.
Patients now have a choice with their post-operative drop regimen. An antibiotic, a steroid, and a non-steroidal anti-inflammatory (NSAID) drop will always be used following cataract surgery. The choice patients now have is how those medications are administered. Traditional drops can be taken, or the patient may elect Drop-A-Day Cataract surgery. Regardless, all patients receive an intra-operative injection of antibiotic, steroid, and NSAID at the conclusion of their procedure. The traditional drop regimen includes 3 separate bottles of drops. However, with the Drop-A-Day regimen, patients use one drop once per day for 4 weeks, simplifying the process for patients and providers. The Drop-A-Day program includes a combination drop that includes all three medications in a single bottle and can be picked up at our office prior to surgery. Regardless of the patient’s drop regimen choice, each patient is provided with a printable drop schedule as a visual and for daily tracking.