Refractive Lens Exchange in the Presbyopic Gray Zone

Optimizing outcomes through patient selection and expectation-setting.

Travis Parker, MD, and Greg Parkhurst, MD

Cataract and Refractive Surgery Today

Presbyopia is profoundly frustrating for patients. This age-related condition manifests as a progressive loss of accommodation that impairs their near and intermediate visual acuity. Patients may strain to read and may experience intermittently blurry distance vision due to accommodative spasm. They also find themselves increasingly reliant on optical aids and other work-arounds to perform everyday tasks—challenges that can substantially erode their quality of life. Refractive lens exchange (RLE) has emerged as a highly effective intervention for the majority of suitable presbyopic patients. The procedure can substantially reduce the spectacle dependence of appropriately selected candidates and enhance their visual function across all distances. In our practice, RLE consistently yields high patient satisfaction rates. The procedure not only corrects presbyopia, but it also preempts future cataract development, making RLE a comprehensive, long-term solution. There is, however, a presbyopic gray zone inhabited by patients who have excellent corrected distance visual acuity, no cataracts, and increasing difficulty with their near visual acuity. Achieving optimal outcomes in these individuals requires meticulous patient selection, a thorough preoperative evaluation, and precise expectation alignment.

Surgical Options for Patients With Cataracts and Open-Angle Glaucoma

Recent studies evaluated the efficacy of MIGS combined with phacoemulsification.

Maxwell de la Paz, BS, and Linda M. Tsai, MD

Cataract and Refractive Surgery Today

Key Takeaways Recent studies have evaluated the efficacy of MIGS combined with phacoemulsification in eyes with open-angle glaucoma. Trabecular procedures combined with cataract surgery provided a greater IOP reduction than cataract surgery alone in patients with hypertensive open-angle glaucoma. Compared to phacoemulsification alone, combining the procedure with MIGS appeared to provide a greater reduction in IOP and the number of medications required postoperatively without decreasing safety. Trabecular Procedures Combined with Cataract Surgery for Open- Angle Glaucoma: A Report by the American Academy of Ophthalmology Richter GM, Takusagawa HL, Sit AJ, et al1Industry support for this study: None ABSTRACT SUMMARY This report compared the IOP reduction of various trabecular procedures combined with cataract surgery to that of cataract surgery alone in patients with hypertensive open-angle glaucoma (OAG). Patient-specific considerations that might guide procedure selection were also investigated. STUDY IN BRIEF A report drawing on 10 randomized controlled trials found that combining trabecular procedures with cataract surgery provided a greater IOP reduction than cataract surgery alone in patients with hypertensive open-angle glaucoma. The trabecular procedures themselves showed no clear benefits over one another for IOP or medication reduction, but direct comparison studies are required. The risks of uveitis and bleeding were among the factors that might influence surgeons’ choice of trabecular procedure. WHY IT MATTERS In patients with well-controlled hypertensive open-angle glaucoma, cataract surgery may reduce their medication burden by 0.8 to 1 at 2 years. When cataract surgery is combined with a trabecular procedure, a further 0.4-reduction may occur.1,2 Because the combined trabecular procedures in this AAO report offered similar benefits, patient factors and surgeon preference may be more important when offering specific options.

Racial/Ethnic Disparities in TDR, DME, and Other Vision Threats in Patients With DR

Jordan Deaner, MD; Vaidehi Dedania, MD; and Rehan Hussain, MD

Eyetube

Are patients with DR at higher risk for TDR, DME, vitreous hemorrhage, or blindness based on race or ethnicity ? Jordan Deaner, MD, moderates a discussion with Vaidehi Dedania, MD, and Rehan Hussain, MD, about a large retrospective cohort study examining more than 627,000 US patients with DR. The panel examines why Black and Hispanic patients faced significantly higher rates of adverse outcomes at  1 and 5 years after diagnosis and unpacks what confounding variables the study could not capture. They consider what these findings should mean for screening strategies, patient education, and the day-to-day management of high-risk diabetic patients in clinic.