Eyeworld

DECEMBER 2023 | EYEWORLD | 33 C LESSONS LEARNED by Ellen Stodola Editorial Co-Director About the physicians Rom Kandavel, MD Colvard-Kandavel Eye Center Encino, California Mitra Nejad, MD Assistant Professor of Ophthalmology David Geffen School of Medicine University of California, Los Angeles Los Angeles, California Amandeep Rai, MD, FRCSC Residency Program Director Department of Ophthalmology & Vision Sciences University of Toronto Toronto, Canada Dr. Nejad said these might need to be operated on more quickly because the cataract is impair- ing the physician's ability to provide treatment for the retina pathology. Dr. Nejad said it's rare that the cataract surgery must happen urgently. However, she noted that some patients come in having failed a driving test, and she wants to address these patients as soon as possible to get them back to functional status. "Otherwise, I usually tell the patient, 'The cataract is significant, I think you should consider surgery, but the good news is there's nothing urgent about it, and you can schedule the surgery at your convenience.'" If the cataract is mild and the patient isn't eager to do surgery, Dr. Nejad will ask the patient to come back in a year. If the cataract is dense and the patient isn't eager to have surgery, she'll have them return sooner. Dr. Nejad has noticed that because patients are hearing good things from family and friends about refractive cata- ract surgery, this decreases their overall anxiety about eye surgery. Dr. Nejad noted that she has seen a wave of worse pathology with the COVID-19 pandemic because patients have gotten used to a life- style with less driving and more time at home. Patients weren't coming in for elective proce- dures and weren't noticing visual impairment as much until they had to go out and drive at night again. "For a while, I was seeing a lot of advanced cataracts, a lot of people who waited longer than they should have," she said. Amandeep Rai, MD, has also found that coming out of the pandemic, there has been a noticeable trend toward patients presenting with more advanced cataracts. "The delayed access has certainly resulted in more patients presenting with advanced, visually significant cataracts in the last 2 years," he said. "However, I do see a fair number of patients with milder symptoms who are referred from their optome- trist for a surgical consult," he said. "If they are minimally symptomatic, I will often ask them to follow up with the optometrist until the cataract becomes more advanced." The decision to proceed with cataract surgery is jointly made by the patient and the B efore deciding to move forward with cataract surgery, there are a variety of factors that surgeons must consider. Several physicians discussed the timing of the surgery and how they counsel patients about this. Mitra Nejad, MD, said it's less about how advanced the cataract is on the exam and more about the patient's description of how they are bothered by their vision. Dr. Nejad has a mix of patients, including referrals from colleagues, so she often sees more visually significant cataracts that are ready for surgery. "On the other hand, I'll get some self-referrals or primary care phy- sician referrals for evaluation of cataract, and I often schedule those alongside an optometrist who I work closely with, in case all they need is an updated glasses prescription," she said. When getting referrals from retina colleagues, Considerations for proceeding with cataract surgery continued on page 34 Dr. Kandavel tries to establish a strong personal connection with patients over years of appointments or even in one meaningful consultation. "Trust is the key to patients following your surgical recommendations," he said. Source: Rom Kandavel, MD

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