Dysfunctional Lens Syndrome, a New Way to Educate Patients

The term “dysfunctional lens syndrome” has been around for 15 years, but more physicians are adopting it as a way to improve both patient education and satisfaction.

“This is fun to do. Everyone is doing it now, and I think you’ll find it satisfying,” said Daniel S. Durrie, MD, speaking at Refractive Surgery Subspecialty Day on Friday.

A continuum of progression. The term describes the natural changes in the crystalline lens after approximately age 42. It’s a continuum that begins the day a person is born. When patients understand the lens aging process, they better understand their options.

Dr. Durrie finds this especially true of patients who had keratorefractive surgery and now need reading glasses. They come to him complaining that “my LASIK has worn off,” unaware that their lens is changing. The cornea is not the culprit.

Staging. The term has become more popular since it was stratified into stages, which aids in patient education. “It’s a new language, and it explains why they are experiencing the symptoms,” Dr. Durrie said. He outlined the stages as follows:

Stage 1: 42-50 year olds

• Lens starts to stiffen, loses focusing power
• Loss of near vision
• Development of higher-order aberrations
• Treatment options: Potential candidates for corneal laser mono/blended vision and corneal inlays

Stage 2:  50 years and older

• Loss of accommodation
• Light scatter formation degrading vision
• Decreased contrast and night vision
• Treatment options: Potential candidates for refractive lens exchange or mono/blended laser surgery with good education

Stage 3: 65 years and older

• Full cataract
• Poor visual quality
• Nucleus of the lens yellows, affects color perception
• Opacity with degraded vision

Talking to patients about dysfunctional lens syndrome is something you can do immediately. It can be done with or without extra equipment, using eye models, Eyemaginations, or TouchMD, or you can use more sophisticated equipment such as the Pentacam or Galilei to show lens density, HD Analyzer to show optical scatter, or slit-lamp photographs.—Susanne Medeiros

Financial disclosures. Dr. Durrie: Abbott Medical Optics: L,S; AcuFocus, Inc.: C,L,O,S; Alcon Laboratories, Inc.: S; Allergan: S; Alphaeon: C,L,O; Avedro: L,O,S; Hoopes Durrie Rivera Research Center: C; Strathspey Crown LLC: C,L,O; Wavetec: O.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.