Clinical Scorecard: Trying to Avoid the Unavoidable

At a Glance

Key Highlights

• Presbyopia is unavoidable and affects nearly 130 million Americans.
• Personalized, age- and refractive error-dependent approaches are essential for treatment.
• Advanced IOL technologies and nonsurgical options expand treatment choices but require careful expectation management.

Guideline-Based Recommendations

Diagnosis

• Evaluate patient age, lens status, and refractive errors (myopia, hyperopia).
• Assess patient goals and lifestyle to guide treatment selection.

Management

• Consider refractive lens exchange with advanced IOLs (monofocal, multifocal, toric, extended depth of focus, accommodative, Light Adjustable Lens) especially in patients 45 years and older.
• Use phakic IOLs as an off-label option for high myopes over 45 as a bridge treatment.
• Trial monovision with contact lenses or laser vision correction to assess tolerance before surgical intervention.
• Offer nonsurgical options including glasses, contact lenses, and presbyopia drops (pending FDA approval).
• Educate patients that LASIK may not directly treat presbyopia in all cases.
• Consider laser scleral microporation as investigational.

Monitoring & Follow-up

• Monitor for retinal complications, especially in high myopes at risk for retinal detachment.
• Manage ocular surface and dry eye disease pre- and postoperatively to optimize outcomes.
• Follow up for adaptation to multifocal lenses and address visual disturbances.
• Be prepared for additional procedures such as laser capsulotomy or astigmatism fine-tuning.

Risks

• Risks similar to cataract surgery including floaters and retinal problems.
• Potential need for adaptation period with multifocal IOLs.
• Possible requirement for secondary procedures to optimize vision.

Patient & Prescribing Data

Adults in their 40s to 70s with presbyopia, including high myopes and hyperopes

Patients increasingly seek earlier intervention with advanced IOL technologies; careful patient selection and expectation setting are critical to satisfaction.

Clinical Best Practices

• Use a personalized approach considering age, refractive error, lens status, and patient goals.
• Set realistic expectations emphasizing that artificial lenses differ from the natural lens.
• Trial monovision nonsurgically before surgical commitment.
• Optimize ocular surface health to improve surgical outcomes.
• Educate patients about the adaptation period and potential need for additional procedures.

References

• RxSight Light Adjustable Lens