“The only thing I dislike more than a rock-hard cataract is an unhappy multifocal IOL patient,” said David F. Chang, MD, during Monday’s Cataract Spotlight Session.
Dr. Chang presented these 2 examples of cataract complications, along with 6 other cases drawn from his own practice. Panelists—who had not previously seen the cases—offered their observations and recommendations; speakers discussed relevant surgical pearls; and, as in previous Cataract Spotlight Sessions, audience members voted in real time on management questions and dilemmas. Despite the variety of problems addressed, several common themes emerged.
Take time to prepare the patient. For example, with regard to unhappy multifocal IOL patients, “If an IOL exchange is needed, patients receive this information postoperatively better if it is not ‘new news,’ and [the possibility] was discussed preoperatively with them,” commented Kerry D. Solomon, MD.
For his part, Steven J. Dell, MD, works to identify the goals of prospective multifocal IOL patients preoperatively, to disclose pros and cons, and to identify and exclude patients who have unrealistic expectations. “And don’t pressure patients [to accept a particular IOL],” he said. In addition, like several other speakers, Dr. Dell noted that it was better to “underpromise and overdeliver.”
Don’t dismiss patient concerns. Postoperatively, when a patient is dissatisfied, “What is the real complaint?” Dr. Dell asked. “It’s critical to identify the true issues.” Again, speaking of unhappy multifocal IOL patients, he noted that they tend to have multiple grievances. “Don’t minimize their complaints, reassure them that you won’t give up, and clearly explain your plan” for remedying the problem, Dr. Dell said. “Patients must feel that they’re being heard.”
Be agile. It’s also important to prepare yourself, speakers noted. That begins with the surgical plan, which Samuel Masket, MD, referenced in a discussion of how to handle the crowded anterior chamber. As for surgical supplies that might be needed for a complex case, “It’s worth taking the extra time to have your tools available,” said Kendall Donaldson, MD.
Old skills may save the day. During one challenging case, Dr. Chang decided to stop phaco and convert to manual extracapsular surgery. Although many younger cataract surgeons are unfamiliar with this procedure, “Everyone needs to have this skill in their back pockets,” commented Susan M. MacDonald, MD. “It will make you a more confident surgeon.”
The session closed with Alan S. Crandall, MD, presenting the 2017 Kelman Lecture—Phaco at 50: The Collision of Cataract and Glaucoma (Plus). (Read Dr. Crandall’s summary of the lecture.)—Jean Shaw
Financial disclosures. Dr. Chang: Carl Zeiss Inc: C; Eyenovia: O; Iantech: C,O; ICON bioscience: O; iDrops: C,O; Ivantis: C,O; Johnson & Johnson Vision: C; Mynosys: O,C; PowerVision Inc: C,O; RX Sight: O,C; SLACK, Incorporated: P; Versant Ventures: O. Dr. Dell: Advanced Tear Diagnostics: C; Allergan: C; Bausch + Lomb: C; Johnson & Johnson: C; Lumenis, Inc.: C; Optical Express: C; Presbyopia Therapies: C,O; Tracey Technologies: O,C. Dr. Donaldson: Abbott Medical Optics Inc.: C,L; Alcon Laboratories, Inc.: C,L; Allergan: C; Bio-Tissue, Inc.: C; Omeros: C; PRN Physician Recommended Nutriceuticals: L; Shire: C; SUN: C; Tear Lab: C. Dr. MacDonald: Alcon: C; Perfect Lens: C. Dr. Masket: Accutome, Inc.: S; Alcon Laboratories, Inc.: C,L; Haag-Streit: C,P; Morcher GmbH: P; MST Surgical: L; Ocular Science: O,C; Ocular Theraputix: C,O; PowerVision: C; VisionCare Ophthalmic Technologies: C. Dr. Solomon: Alcon Laboratories, Inc.: C,L,S; Allergan: C,O; Bausch + Lomb: S; Glaukos Corporation: C,O; Lenstec, Inc.: S; PRN Physician Recommended Nutriceuticals: C,O.
Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.