The Pursuit of Perfect Vision

A New Catchphrase: Refractive Cataract Surgery

Mark H. Blecher, MD: Hello. I'm Dr. Mark Blecher, Co-director of Cataract and Primary Eye Care at Wills Eye Hospital in Philadelphia. Welcome to Medscape Ophthalmology Insights, coming from the American Academy of Ophthalmology (AAO) meeting in New Orleans. This is part of a series of commentaries produced in cooperation between Medscape and Wills Eye Hospital.

Joining me today are Dr. Joanna Fisher and Dr. Brandon Ayres of Wills Eye Hospital. Dr. Fisher is a member of the Cataract and Primary Eye Care Service, and Dr. Ayres is a member of the Cornea Service.

Today we will be discussing some of the more exciting developments in cataract and refractive surgery that we found at this year's meeting.

A topic that has been discussed very actively the past few years -- it has almost become a new catchphrase -- is refractive cataract surgery. Brandon, we are talking about not only taking out the cataract safely, effectively, and efficiently; we are talking about improving patients' visual function beyond what they lost from the cataract. What do you think?

Brandon D. Ayres, MD: Over the past couple of years, and especially at this year's meeting, we have run into the almost relentless pursuit of emmetropia and using many different technologies to try to achieve that. This extends from the front end (trying to get better biometry and better measurements) all the way to treatment (doing the surgery more accurately) through checking your intraocular lens (IOL) powers on the back end. There has been a big paradigm shift here, from just extracting the lens in cataract surgery and being safe, to maximizing the postoperative outcome.

Joanna M. Fisher, MD: Yes, I agree.

Dr. Blecher: Joanna, do you think everyone buys into this? Is every cataract surgeon interested in doing refractive cataract surgery?

Dr. Fisher: Everybody is interested, Mark. It's here; it's accepted. The issues will be how to incorporate it into our practices and the financial challenges that we are facing, which are significant.

Dr. Blecher: We have all these new technologies. They are not cheap. Lord knows we are not being paid more money to do the surgery, and our facilities are not being paid more either. So it's a challenge.