When I was approached to become a guest editor of the April issue of Ophthalmology Management, I welcomed the opportunity with some trepidation. I have been in a private practice for nearly 34 years following US Naval service and have benefitted from the experience and insights of my colleagues in the pages of Ophthalmology Management during its 25 years of publication, particularly in regard to clinical practice, ASC management, anterior segment surgery and diagnostic technology. It is a privilege to be involved with this issue.

CHALLENGES OF REFRACTIVE CATARACT SURGERY

I recently reflected on several of my refractive cataract surgery patients who presented with a variety of anterior segment comorbidities, including dry eye disease, glaucoma, corneal graft, intracorneal ring segments and prior phakic IOLs. Each one had the goal of reducing spectacle dependency while preserving visual quality. These cases required significant preparation, including extensive patient education with expectation management, ocular surface optimization, aberrometry assessment, astigmatism management and premium IOL selection along with femtosecond laser and image guidance technology. The successful refractive outcomes with patient satisfaction were particularly gratifying in light of the unique challenges involved.

However, surgical complications and poor patient selection may create undesirable experiences, which may cause disengagement with refractive cataract surgery. Complications and comorbidities may further result in limited spectacle-free vision, unwanted visual disturbances, worsened dry eye disease symptoms and continued need for glaucoma medications. The refractive cataract surgeon must have the skillset and tools to manage these situations to the patient’s satisfaction.

THIS ISSUE

This issue of Ophthalmology Management draws attention to the unique considerations of refractive cataract surgery in general as well as in the presence of significant comorbidities. Dr. P. Dee G. Stephenson offers sage advice to surgeons that should encourage adoption of toric and presbyopia-correcting IOLs that are significantly underutilized.

One source of trepidation with refractive cataract surgery is the dreaded intraoperative complication that results in a change in the surgical plan. Dr. Lisa Nijm provides insight in the art of managing the eye, the patient and yourself when a complication occurs to achieve a successful outcome and a happy patient.

Patients may now have a pharmacologic solution when presbyopia-correcting lenses provide less than robust near vision. Drs. Ralph Chu and Jessica Heckman share their experience with VUITY (Allergan) presbyopia eyedrops.

Invariably we encounter glaucoma patients requesting refractive cataract surgery. They may have a significant, medication burden or intolerance as well as contrast sensitivity loss. Drs. Steven Vold and Michael McFarland share their experience with minimally invasive glaucoma surgery, premium IOL selection and patient counseling in refractive cataract surgery in glaucoma patients.

As an added treat for those surgeons with ASC ownership interest, Patti Barkey, COE, provides a look at current reimbursement issues that impact cost containment. Further, we highlight innovative EHR features that may facilitate productive patient interactions to enhance the refractive cataract surgery experience.

These contributors are respected colleagues and friends whose expertise and insights illustrate current challenges and opportunities in the presence of ocular comorbidities.

REACHING OUR GOALS

In my refractive cataract patients, visual quality is as important as visual acuity. I hope this issue of OM draws attention to the art of achieving both goals to enhance the surgical experience for our patients. OM

Frank W. Bowden III, MD, FACS, is a cornea, refractive, glaucoma and cataract surgeon and a recognized dry eye expert. He is the medical director and founder of Bowden Eye & Associates and president and medical director of Eye Surgery Center of North Florida. He is a founding partner of Dry Eye University and Dry Eye Access.