Eyeworld

WINTER 2025 | EYEWORLD | 33 C surgical technique mean that many of our pa- tients don't need steroids postop, and since we don't put in stitches, we don't need to take pa- tients back to the OR later to remove them. The surgeries are gentler, faster, and more forgiving than they were even 10 years ago." Still, it requires effort—and a mindset shift, she said. Surgeons may need to operate stand- ing up or adapt microscope positioning for pa- tients who cannot lie flat. "I do cataract surgery standing up about once a month," Dr. Rowe said. "It's about meeting patients where they are, not asking them to accommodate to us." When Dr. Braga-Mele has a patient who is neurodiverse or has a mental disability, she said it can be hard to perform the examination and get biometry. Intraoperative aberrometry can be helpful in these cases, but if not available, you may have to use an average lens power. "You're trying to make them better. If they have to wear glasses, it's not the end of the world," Dr. Braga- Mele said. She added that some of these patients will require general anesthesia, and if they do, she'll also consider bilateral same-day cataract surgery. Dr. Braga-Mele said she carefully cleans the capsule for these cases to reduce the risk of PCO (and thus later YAG). Even with small "He had white cataracts, and after surgery, his 'dementia' disappeared. It turned out that he didn't have dementia; he just couldn't see, and he couldn't tell anyone. He started walking again, lost weight, the skin infections in his ab- dominal folds cleared up. He was no longer in a wheelchair," she said, giving this as an example of the profound impact of restored vision. Dr. Ledoux shared a similar anecdote of a boy who had cognitive impairment who had his cataracts removed by another pediatric ophthal- mologist. When the patch and shield were taken off at a postop appointment, the boy, who had been wheelchair dependent, got up and walked out of the room. "The entire reason he was wheelchair dependent was that he'd stopped being able to see comfortably," Dr. Ledoux said. Dr. Ledoux said she sees this population as "a group of people who just needs regular care. Once you have a sense for the person and the family, when it comes time to take out their cat- aracts or whatever needs to be done [to improve their vision], it's the same as any patient. It just takes a little longer—and I don't think every part is longer. The biggest thing is patience and using different methodology for getting their vision checked." Barrier 2: risk assumptions and surgical feasibility Even when need is established, perceived surgical risk can halt progress. Patients who are neurodiverse, non-speaking, or have behavior- al conditions may not tolerate shields, postop drops, or standard protective protocols. Dr. Rowe said she has performed more than 250 surgeries on such patients without postop patches or shields—and without complications. "We're trying to help surgeons understand that it's possible to do this work safely," Dr. Rowe said. "The idea that something terrible is definitely going to happen if a patient doesn't wear a shield or even if they rub their eyes isn't supported by our evidence." Technological advances support this safer environment as well. "Sutureless, clear cor- nea surgery changed everything," Dr. Rowe explained. "Highly effective phaco technology, intracameral antibiotics, and a truly atraumatic continued on page 34 " … there is no greater satisfaction than giving someone who could potentially not advocate for themselves the ability to receive the same healthcare as everyone else and give them their sight back." —Rosa Braga-Mele, MD

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