Eyeworld

52 | EYEWORLD | DECEMBER 2020 ATARACT C About the physician Hercules Logothetis, MD Eye Physicians of Libertyville Libertyville, Illinois Reference 1. Logothetis HD, Feder RS. Which intraocular lens would ophthal- mologists choose for them- selves? Eye. 2019;33:1635–1641. Relevant disclosures Logothetis: None by Liz Hillman Editorial Co-Director and most (67%) had been in practice for more than 10 years. More than 60% of respondents were presbyopic. About 85% of respondents performed cataract surgery, and 67.7% used presbyopia-correcting IOLs to some extent. Ninety-three percent of respondents said quality of vision would be most important in their own cataract surgery, and 43.1% said glasses independence would also be important to them (25.4% said it wouldn't be important to What IOL would you choose, doc? P atients often seek their ophthalmolo- gist's expert opinion for the IOL they would recommend if they were in the patient's situation. As a resident at Northwestern University, Hercules Logothetis, MD, and his mentor Robert Feder, MD, actually asked ophthalmologists about the technology they would choose for themselves. 1 "As a resident learning cataract surgery, I became interested in IOL selection and would survey mentors and peers about what they would choose if they were the patient," Dr. Logothetis said, speaking about what spurred this research. "I thought it was important to know if surgeons were comfortable performing surgical techniques on patients that they may not choose for themselves. That question is complicated. Just because a surgeon prefers one option over another for themselves, it doesn't mean they don't support the safety or efficacy of the option they don't choose." Dr. Logothetis and his coresearchers used a 29-question survey to ask surgeons about not only IOL choice but also femtosecond laser-assisted cataract surgery (FLACS), their IOL preferences for patients, their person- al perspective of risk, and more. The survey garnered 347 responses (328 of which were analyzed) in a 1-month period. The average age of survey respondents was 50.3 (±12.8 years), continued on page 54 Postoperative considerations Some patients may require follow-up with a ret- ina specialist. "All these complex surgeries that incur vitreous removal can pose a risk to the retina," Dr. Chee said. "I generally will give the patients the necessary advice and screen their retinas starting as early as 10 days postopera- tively and at almost every consult. I only refer if I am suspicious of a retinal problem." She added that when dealing with a highly myopic eye that is at an increased risk of IOL subluxation, she prefers that the retina surgeon screen the eyes for retinal breaks prior to surgery. "I also per- form OCT of the macula if the vision is not as good as expected to detect and treat CME early." Dr. Chee said it's also important to look out for raised IOP, persistent inflammation, and en- dothelial cell loss, in addition to retinal issues. In terms of medications to use, Dr. Chee said that with intrascleral haptic fixation, the in- flammation resolves within a month, and using topical steroids, antibiotics, and a topical NSAID for 1 month is adequate. With iris fixation, these eyes require the same medications but some- times for 3–4 months after surgery. Dr. Rocha noted that she uses the same drops that she uses for regular cataract patients. But she watches for CME postop especially in iris fixated lenses, she said, adding that it's also important to monitor for IOP spikes. continued from page 50 "Just because a surgeon prefers one option over another for themselves, it doesn't mean they don't support the safety or efficacy of the option they don't choose." —Hercules Logothetis, MD

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