APR 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/119916

Contents of this Issue


Page 58 of 82

56 EW REFRACTIVE SURGERY April 2013 Functionality over fashion: Spectacle independence not the only benefit of presbyopia-correcting IOLs by Ehsan "Ethan" Sadri, MD P resbyopia-correcting IOLs are often considered by younger patients who desire spectacle independence. However, elderly patients who are less concerned about spectacle independence can also benefit greatly from cataract extraction and presbyopia-correcting IOL implantation. There has been a lot of emphasis on the glasses versus no glasses result of cataract surgery. However, depth of focus for older patients may be a more important result. Functionally, this means that seniors who have stairs in their home and who may not have loved ones close by are safer because they have good depth of focus. In fact, a recent major study of Medicare beneficiaries has found that the risk of hip fractures was significantly reduced in patients who had cataract surgery compared with patients who did not undergo the procedure.1 There were 1.1 million U.S. Medicare beneficiaries who were 65 years of age and older who had a diagnosis of cataract between 2002 and 2009. Of these patients, 410,809 (36.9%) underwent cataract surgery during the study period. Compared with the one-year hip fracture incidence in patients with cataract who did not have cataract surgery, the adjusted odds ratio of hip fracture within one year after cataract surgery was 0.84 with an absolute risk difference of 0.20%. Compared with matched subgroups of patients who did not undergo cataract surgery, patient subgroups that experienced lower odds of hip fracture after cataract surgery included patients with severe cataract, patients most likely to receive cataract surgery based on propensity score, patients 75 years and older, and patients with a Charlson comorbidity index score of 3 or greater. This is an important finding because fractures secondary to falls are a significant cause of morbidity and mortality in elderly patients. Visual impairment has been found to be strongly associated with an increased risk of fractures, with reports of increased fracture incidence in patients with poor visual acuity, depth perception, contrast sensitivity, and visual field loss. However, while replacing a clouded lens with a clear pseudophakic one provides many benefits, it does not provide multifocality and depth of focus, which could benefit elderly patients even more. I always explain this benefit to patients when they are choosing a lens. While many refractive lens exchange patients choose these lenses because they desire spectacle independence, there is a large group of patients who require cataract surgery and could benefit from these lenses. Four or five years ago, I started interviewing patients and analyzing their living situations to determine the best IOLs for them. I evaluated how confident they were with their equilibrium, their gaits, and their mobility around the house, and my findings were pretty surprising. The majority of the patients surveyed had much more confidence in their ability to navigate familiar and unfamiliar territory because of the presbyopia-correcting aspect of their vision correction. As an example, I recently implanted presbyopia-correcting IOLs in a 72-year-old woman. Her preoperative best corrected visual acuity was 20/70 in both eyes. Thirty minutes after IOL implantation, her uncorrected distance visual acuity was 20/25 in both eyes and her uncorrected near visual acuity was J1/J2. She reports being more stable on her feet and loves the result. She reports excellent stereovision. While many patients value uncorrected vision, people value safety more. While these lenses are not for everyone, they are a great choice for those who live alone, especially if they have stairs and don't have any loved ones around. Those patients who live in nursing homes with round-the-clock nursing care are probably not the best candidates for this treatment. EW Reference Tseng VL, Yu F, Lum F, Coleman AL. Risk of fractures following cataract surgery in Medicare Beneļ¬ciaries. JAMA. 2012;308(5):493-501. Editors' note: Dr. Sadri is in private practice in Newport Beach, Calif. He has financial interests with Allergan (Irvine, Calif.) and Abbott Medical Optics (Santa Ana, Calif.). Contact information Sadri: esadrii@gmail.com, 949-642-3100

Articles in this issue

Links on this page

Archives of this issue

view archives of Eyeworld - APR 2013