Stephen G. Slade, MD, FACS, encouraged his audience of surgeons to “think like a patient” when it comes to refractive lens exchange (RLE), as he delivered the Roger G. Steinert Lecture at the ASCRS annual meeting in Boston on Friday. “I will take you through my thoughts on this, with an emphasis on how Roger would have thought about [RLE],” said Dr. Slade, a surgeon at the Slade and Baker Vision Center in Houston. Dr. Steinert (1950-2017) was a president of ASCRS and a respected surgeon who pioneered advances in laser surgery techniques and corneal transplantation.

In Dr. Slade’s view, Roger Steinert would have recognized RLE as a “third wave” in anterior segment surgery, following incisional keratotomy and LASIK. “Patients get it,” he said. “Why are we doing all this RLE? Because we have the lenses that are finally good enough and patients get it. They say, ‘You mean if I have this done, I don't have to have cataract surgery later?’ Now, if you think like a patient, that's a big deal. So we're doing earlier surgery and that translates to more surgery.

“One of the best pieces of advice I got is, follow the baby boomers,” he continued. “When they were the right age, they were ones that got crazy amounts of LASIK. As they got older, they are the ones who are making refractive lens exchanges. These are my people. I know these people. And it's a value proposition because they're paying for it. So, they're really going to value and look at the risks versus the benefits.” Most RLE patients are very interested in the possibility of correcting presbyopia, he notes.

“If I had a wish list, I’d want to improve and increase my phakic IOL use, because it's a bridge between Lasik and RLE,” Dr. Slade continued. “It keeps the people in the practice. You don't wanna be a catch-and-release fisherman; you wanna be a catch and keep. I wish we had a really good accommodating IOL. I wish we had a more perfect multifocal. I wish we had an IOL simulator, where we could literally show people what their vision would be like.

So, finishing up, its refractive surgery. It's done on healthy eyes. The people are expecting perfect. And you are the patients, or you will be. This is the surgery that you will have, so learn about it. The patient has the vote in elective surgery. It's a value-based proposition. LASIK worked because it gave people great vision quickly and it had a wow factor.”

Dr. Slade closed his speech by discussing Dr. Steinert, a friend and colleague. “The last time I saw Roger was at an ASCRS meeting, and he was in a wheelchair because of his disease, his cancer,” he told the audience. “And I kneeled down to talk to Roger and we had a conversation in the hallway, and he said to me, ‘We have to carry on.’ Those were his last words to me. I can’t think of a better piece of advice.”