This week I hosted 30 optometrists for dinner at Chianti restaurant in Adelaide. It was a great chance to get to know each other, talk about cataract and refractive surgery and enjoy some good food and wine. I gave three talks about what is new in ophthalmology and especially in cataract surgery as well as laser vision correction. My first presentation was about the new wave of intraocular lenses (IOLs) available for patients to improve their visual function. Some of the newer lenses that excite me are the monofocal aspheric Clareon with AutonoMe injector from Alcon; the Eyhance monofocal plus option from Johnson & Johnson; the extended range of vision IOL, Vivity from Alcon and the hybrid multifocal and extended depth of focus IOL, Synergy from Johnson & Johnson. Having all of these IOLs at my disposal does not mean that I use them without thought. Each patient has a plan made for them as an individual. I feel that a long discussion about the pros and cons of each option pre-operatively makes a huge difference to patient satisfaction post-operatively. Not every option is suitable for every eye or every patient. My message was that each optometrist usually knows their cataract patient better than me so if they can know the options available and advise me on the visual needs of their patient then this team approach can make things far easier and better in the long run for everyone.
My second talk of the evening was about lens surgery for irregular corneas. These are eyes that have had radial keratotomies, scars, previous trauma or infections. Eyes where a simple pair of glasses or contacts just don't work well. A small aperture IOL such as the IC8 can be amazing in these situations and I showed a case where this made a huge difference to quality of life for a patient who had undergone multiple refractive procedures. The lens works like a pinhole so it has a wide range of targets that will be acceptable to the patient. This is ideal for eyes that vary throughout the day. It was originally marketed as an IOL for use to give intermediate and near vision but I prefer to use it as a therapeutic option.
The final presentation of the evening was about managing the unhappy refractive patient. Not that I ever have any!! We all have patients who have undergone procedures, perhaps elsewhere, and are not happy with their outcome for some reason. Whether this is because of a mismatch between expectations and outcome or truly a suboptimal outcome, there are solutions. I discussed options of laser enhancement of vision, additional or supplementary IOL options and even the addition of a multifocal IOL for eyes that have previously had cataract surgery. There are so many great options for fixing these situations these days that all patients should at least have a chance to discuss these options and see if there is anything that would make their life better.
Overall it was a wonderful night and I really enjoyed getting to know some of my optometrist colleagues better. I am always happy to discuss these options I was discussing. I'm looking forward to further educational events. Now to get those CPD points organised for everyone!