Eyeworld

WINTER 2024 | EYEWORLD | 33 C by Liz Hillman Editorial Co-Director About the physicians Rosa Braga-Mele, MD Professor of Ophthalmology University of Toronto Toronto, Canada Kendall Donaldson, MD, MS Medical Director Bascom Palmer Eye Institute, Plantation Professor of Clinical Ophthal- mology Rodgers Clark Endowed Chair in Ophthalmology Plantation and Miami, Florida Jonathan Rubenstein Chairman and Deutsch Family Endowed Professor Department of Ophthalmology Rush University Medical Center Chicago, Illinois the emphasis on some of the tradeoffs patients might experience, she said, while others might be a new category, like accommodating IOLs, that would add to the conversation in some ways. "I don't think there will ever be a lens that is one size fits all. I don't think that's going to come … in my career, though I could be wrong," Dr. Braga-Mele said. Something that she thinks is needed, and that is in the pipeline, are better diagnostics. "As Warren Hill says, 'Garbage in, garbage out.' What we need is better diagnostics that give us much more confidence in our lens choices," she said, adding that these along with AI are com- ing soon. "We'll see better diagnostics to make better choices and predictions for our patients. That is going to be the key in making better decisions for what to offer patients." Something she'd like is a simulator that helps show the patient what different lenses and dysphotopsia profiles will be like. 'This is one of the most time-consuming responsibilities' Kendall Donaldson, MD, MS Dr. Donaldson's patient education begins before they even meet. "I find that it is much easier to discuss lens options if the patient has a little background going into the discussion. I prepared a 7-minute video of myself succinctly explaining what cata- ract surgery is and what lens options are avail- able," she said, noting that patients often come in with questions about laser cataract surgery vs. ultrasound cataract surgery but are overall unaware of the various lens options. "The video reviews the basics of what cataract surgery is, as well as answers to the common questions I receive during a typical cataract consultation. I find that this video brings everyone to the same level for our discussion." From there, Dr. Donaldson said that she tries to acquire imaging (topography, biometry, and macular OCT) before performing the slit lamp exam. This helps her determine which lenses the patient might be a candidate for. "Depending on the patient's questions, their astuteness, and their level of anxiety, sometimes their questions make me go, 'Maybe this patient is not good for a trifocal IOL because nothing is going to make them happy,'" she said. To further understand patient personali- ties, Dr. Braga-Mele said she'll often reveal a bit about her own. "Sometimes I say to patients, 'I'm OCD and I like things to be a certain way. I am just meeting you for the first time, so can you tell me what your personality is like because then I'll know what kind of lens suits you best?' If you say it that way, where you put yourself in the position of being high anxiety, high OCD … it shortens the conversation a bit, and the patient is not offended," she said. Even with a detailed discussion based on your observations and assessments of the eye and the patient's visual desires and personal- ity, Dr. Braga-Mele said about 5% of patients either won't understand or will later regret their choice. "There is only so much you can do. You have to at least broad stroke and spend a couple of minutes telling them what's out there. You have to let your patients know they're available, and if they want them, they can go see another doctor if you don't feel comfortable using those IOLs," she said. IOL options have evolved significantly during Dr. Braga-Mele's time in practice. She said toric was not available when she first started out; there were monofocal, non-foldable PMMA lenses, making the patient discussion of options virtually non-existent. "It was a lot easier in some ways back then," she said. For those who are just starting to have more of these complex IOL selection conversations, Dr. Braga-Mele said to not be daunted by the initial time it may take. "It does evolve over time. You get more efficient in conveying the message of what the lenses are. I have to say, 80–90% of patients get it," she said, adding that anything you can do to pre-educate your patients on the different IOL categories helps when they're in your chair. Dr. Braga-Mele said she thinks there will be future iterations of IOLs that will progress the conversation. Some IOLs will likely have less of a dysphotopsia profile, reducing the need for continued on page 34

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